Advertisement

Heart and Vessels

, Volume 30, Issue 3, pp 347–354 | Cite as

Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions

  • Murat Sunbul
  • Dilek Seckin
  • Erdal Durmus
  • Zuleyha Ozgen
  • Mehmet Bozbay
  • Ayfer Bozbay
  • Tarik Kivrak
  • Mustafa Oguz
  • Ibrahim Sari
  • Tulin Ergun
  • Mehmet Agirbasli
Original Article

Abstract

Arterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 ± 13.2 years) and 50 controls (33 male, mean age 45.0 ± 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 ± 1.78 versus 1.82 ± 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 ± 15.1 and 75.2 ± 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 ± 13.1 versus 17.4 ± 12.3 %, p = 0.001 and 6.78 ± 1.42 versus 6.18 ± 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95 % confidence interval 1.01–1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02–2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.

Keywords

Arterial stiffness Pulse wave velocity Augmentation index Psoriasis Cardiovascular risk Neutrophil-to-lymphocyte ratio 

Notes

Conflict of interest

None to declare.

References

  1. 1.
    Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A (2001) Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 37:1236–1241CrossRefPubMedGoogle Scholar
  2. 2.
    Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J (2006) Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 113:664–670CrossRefPubMedGoogle Scholar
  3. 3.
    Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, Vita JA, Levy D, Benjamin EJ (2010) Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 121:505–511CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Franklin SS (2008) Beyond blood pressure: arterial stiffness as a new biomarker of cardiovascular disease. J Am Soc Hypertens JASH 2:140–151CrossRefGoogle Scholar
  5. 5.
    Payne RA, Wilkinson IB, Webb DJ (2010) Arterial stiffness and hypertension: emerging concepts. Hypertension 55:9–14CrossRefPubMedGoogle Scholar
  6. 6.
    Naldi L (2004) Epidemiology of psoriasis. Curr Drug Targets Inflamm Allergy 3(2):121–128CrossRefPubMedGoogle Scholar
  7. 7.
    Siegel D, Devaraj S, Mitra A, Raychaudhuri SP, Raychaudhuri SK, Jialal I (2013) Inflammation, atherosclerosis, and psoriasis. Clin Rev Allergy Immunol 44(2):194–204CrossRefPubMedGoogle Scholar
  8. 8.
    Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB, Intermountain Heart Collaborative Study Group (2005) Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 45:1638–1643CrossRefPubMedGoogle Scholar
  9. 9.
    Yurtdaş M, Yaylali YT, Kaya Y, Ozdemir M, Ozkan I, Aladağ N (2014) Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis. Echocardiography. doi: 10.1111/echo.12511 Google Scholar
  10. 10.
    Del Rincon I, Williams K, Stern MP, Freeman GL, Escalante A (2001) High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 44:2737–2745CrossRefPubMedGoogle Scholar
  11. 11.
    Asanuma Y, Oeser A, Shintani AK, Turner E, Olsen N, Fazio S, Linton MF, Raggi P, Stein CM (2003) Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med 349:2407–2415CrossRefPubMedGoogle Scholar
  12. 12.
    Yiu KH, Yeung CK, Chan HT, Wong RM, Tam S, Lam KF, Yan GH, Yue WS, Chan HH, Tse HF (2011) Increased arterial stiffness in patients with psoriasis is associated with active systemic inflammation. Br J Dermatol 164(3):514–520PubMedGoogle Scholar
  13. 13.
    Gelfand JM, Mehta NN, Langan SM (2011) Psoriasis and cardiovascular risk: strength in numbers, part II. J Invest Dermatol 131(5):1007–1010CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Sunbul M, Agirbasli M (2014) Psoriasis and atherosclerosis: is there a need for novel biomarkers assessing cardiovascular risk? Curr Pharm Des 20(4):529–535CrossRefPubMedGoogle Scholar
  15. 15.
    Christophers E (2007) Comorbidities in psoriasis. Clin Dermatol 25:529–534CrossRefPubMedGoogle Scholar
  16. 16.
    Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, Giannetti A, Girolomoni G (2007) Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. Br J Dermatol 157:68–73CrossRefPubMedGoogle Scholar
  17. 17.
    Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM (2006) Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 55:829–835CrossRefPubMedGoogle Scholar
  18. 18.
    Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB (2006) Risk of myocardial infarction in patients with psoriasis. JAMA 296:1735–1741CrossRefPubMedGoogle Scholar
  19. 19.
    Gisondi P, Fantin F, Del Giglio M, Valbusa F, Marino F, Zamboni M, Girolomoni G (2009) Chronic plaque psoriasis is associated with increased arterial stiffness. Dermatology 218:110–113CrossRefPubMedGoogle Scholar
  20. 20.
    Wright CI, Brouwer-de Cock KA, Kroner CI, Hoeks AP, Draijer R (2007) The relation of arterial stiffness to endothelial function in healthy subjects. Physiol Meas 28:573–582CrossRefPubMedGoogle Scholar
  21. 21.
    Oliver JJ, Webb DJ (2003) Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vascular Biol 23:554–566CrossRefGoogle Scholar
  22. 22.
    Hamilton PK, Lockhart CJ, Quinn CE, McVeigh GE (2007) Arterial stiffness: clinical relevance, measurement and treatment. Clin Sci (Lond) 113:157–170CrossRefGoogle Scholar
  23. 23.
    Fredriksson T, Pettersson U (1978) Severe psoriasis—oral therapy with a new retinoid. Dermatologica 157:238–244CrossRefPubMedGoogle Scholar
  24. 24.
    Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC Jr, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Faxon DP, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO, ACC; AHA; ASE, (2003) ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr 16:1091–1110PubMedGoogle Scholar
  25. 25.
    Van Bortel LM, Duprez D, Starmans-Kool MJ, Safar ME, Giannattasio C, Cockcroft J, Kaiser DR, Thuillez C (2002) Clinical applications of arterial stiffness, Task Force III: recommendations for user procedures. Am J Hypertens 15:445–452CrossRefPubMedGoogle Scholar
  26. 26.
    Mazlin MB, Chang CC, Baba R (2012) Comorbidities associated with psoriasis-data from the malaysian psoriasis registry. Med J Malaysia 67(5):518–521PubMedGoogle Scholar
  27. 27.
    Doukaki S, Caputo V, Bongiorno MR (2013) Psoriasis and Cardiovascular Risk: assessment by CUORE Project Risk Score in Italian Patients. Dermatol Res Pract 2013:389031PubMedCentralPubMedGoogle Scholar
  28. 28.
    Dowlatshahi EA, Kavousi M, Nijsten T, Ikram MA, Hofman A, Franco OH, Wakkee M (2013) Psoriasis is not associated with atherosclerosis and incident cardiovascular events: the Rotterdam Study. J Invest Dermatol 133(10):2347–2354CrossRefPubMedGoogle Scholar
  29. 29.
    Langan SM, Seminara NM, Shin DB, Troxel AB, Kimmel SE, Mehta NN, Margolis DJ, Gelfand JM (2012) Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol 132:556–562CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Lin YC, Dalal D, Churton S, Brennan DM, Korman NJ, Kim ES, Husni ME (2013) Relationship between metabolic syndrome and carotid intima media thickness: cross-sectional comparison between psoriasis and psoriatic arthritis. Arthritis Care Res (Hoboken). doi: 10.1002/acr.22144 Google Scholar
  31. 31.
    Montaudié H, Albert-Sabonnadière C, Acquacalda E, Fontas E, Danré A, Roux C, Ortonne JP, Lacour JP, Euller-Ziegler L, Passeron T (2013) Impact of systemic treatment of psoriasis on inflammatory parameters and markers of comorbidities and cardiovascular risk: results of a prospective longitudinal observational study. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.12255 PubMedGoogle Scholar
  32. 32.
    Wang Z, Hoy WE (2010) C-reactive protein: an independent predictor of cardiovascular disease in Aboriginal Australians. Aust N Z J Public Health 34(Supp 1):S25–S29CrossRefPubMedGoogle Scholar
  33. 33.
    Bahadursingh S, Beharry K, Maharaj K, Mootoo C, Sharma P, Singh J, Teelucksingh K, Tilluckdharry R (2009) C-reactive protein: adjunct to cardiovascular risk assessment. West Indian Med J 58(6):551–555PubMedGoogle Scholar
  34. 34.
    Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 102(6):653–657CrossRefPubMedGoogle Scholar
  35. 35.
    Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, Cincin A (2013) Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. doi: 10.3109/10641963.2013.804547 Google Scholar
  36. 36.
    Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, Capodilupo R (2011) Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 107(3):433–438CrossRefPubMedGoogle Scholar
  37. 37.
    Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55(13):1318–1327CrossRefPubMedGoogle Scholar
  38. 38.
    Yamada K, Iino S, Isobe S, Kondo T, Izawa H, Inden Y, Yoshikane M, Ikeda N, Hirai M, Sawada K, Murohara T (2012) Relation of plasma catecholamine levels with pulse wave velocity in hypertensive patients compared with normotensive subjects. Heart Vessel 27(5):493–498CrossRefGoogle Scholar
  39. 39.
    Zhang ZY, Bian LQ, Jae SY, Sung JD, Choi YH (2013) Serum total bilirubin is inversely associated with brachial-ankle pulse wave velocity in men with hypertension. Heart Vessel 28(4):453–460CrossRefGoogle Scholar
  40. 40.
    Balta I, Balta S, Demirkol S, Celik T, Ekiz O, Cakar M, Sarlak H, Ozoguz P, Iyisoy A (2013) Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris. Angiology. doi: 10.1177/0003319713485805 Google Scholar
  41. 41.
    Bicer A, Acikel S, Kilic H, Ulukaradag Z, Karasu BB, Cemil BC, Dogan M, Baser K, Cagirci G, Eskioglu F, Akdemir R (2009) Impaired aortic elasticity in patients with psoriasis. Acta Cardiol 64(5):597–602CrossRefPubMedGoogle Scholar
  42. 42.
    Ardic I, Kaya MG, Yarlioglues M, Karadag Z, Dogan A, Yildiz H, Dogdu O, Zencir C, Aktas E, Ergin A (2010) Impaired aortic elastic properties in normotensive patients with psoriasis. Blood Press 19(6):351–358CrossRefPubMedGoogle Scholar
  43. 43.
    Karamanoglu M, Gallagher DE, Avolio AP, O’Rourke MF (1995) Pressure wave propagation in a multibranched model of the human upper limb. Am J Physiol 269:H1363–H1369PubMedGoogle Scholar
  44. 44.
    Pannier B, Avolio AP, Hoeks A, Mancia G, Takazawa K (2002) Methods and devices for measuring arterial compliance in humans. Am J Hypertens 15:743–753CrossRefPubMedGoogle Scholar
  45. 45.
    Rossi A, Bonapace S, Cicoira M, Conte L, Anselmi A, Vassanelli C (2013) Aortic stiffness: an old concept for new insights into the pathophysiology of functional mitral regurgitation. Heart Vessel 28(5):606–612CrossRefGoogle Scholar
  46. 46.
    Sarkola T, Jaeggi E, Slorach C, Hui W, Bradley T, Redington AN (2013) Assessment of vascular remodeling after the Fontan procedure using a novel very high resolution ultrasound method: arterial wall thinning and venous thickening in late follow-up. Heart Vessel 28(1):66–75CrossRefGoogle Scholar
  47. 47.
    Magda SL, Ciobanu AO, Florescu M, Vinereanu D (2013) Comparative reproducibility of the noninvasive ultrasound methods for the assessment of vascular function. Heart Vessel 28(2):143–150CrossRefGoogle Scholar
  48. 48.
    Baulmann J, Schillings U, Rickert S, Uen S, Düsing R, Illyes M, Cziraki A, Nickering G, Mengden T (2008) New oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods. J Hypertens 26:523–528CrossRefPubMedGoogle Scholar
  49. 49.
    Celik A, Ozçetin M, Yerli Y, Damar IH, Kadı H, Koç F, Ceyhan K (2011) Increased aortic pulse wave velocity in obese children. Turk Kardiyol Dern Ars 39:557–562CrossRefPubMedGoogle Scholar
  50. 50.
    Yeboah J, Crouse JR, Hsu FC, Burke GL, Herrington DM (2007) Brachial flow-mediated dilation predicts incident cardiovascular events in older adults: the Cardiovascular Health Study. Circulation 115:2390–2397CrossRefPubMedGoogle Scholar
  51. 51.
    Sunbul M, Tigen K, Ozen G, Durmus E, Kivrak T, Cincin A, Kepez A, Atas H, Direskeneli H, Basaran Y (2013) Evaluation of arterial stiffness and hemodynamics by oscillometric method in patients with systemic sclerosis. Wien Klin Wochenschr 125(15–16):461–466CrossRefPubMedGoogle Scholar
  52. 52.
    Sunbul M, Kanar BG, Durmus E, Kivrak T, Sari I (2013) Acute sleep deprivation is associated with increased arterial stiffness in healthy young adults. Sleep Breath. doi: 10.1007/s11325-013-0873-9 PubMedGoogle Scholar
  53. 53.
    O Hartaigh B, Bosch JA, Carroll D, Hemming K, Pilz S, Loerbroks A, Kleber ME, Grammer TB, Fischer JE, Boehm BO, März W, Thomas GN (2013) Evidence of a synergistic association between heart rate, inflammation, and cardiovascular mortality in patient undergoing coronary angiography. Eur Heart J 34(12):932–941CrossRefPubMedGoogle Scholar
  54. 54.
    Wilkinson IB, Hall IR, MacCallum H, Mackenzie IS, McEniery CM, van der Arend BJ, Shu YE, MacKay LS, Webb DJ, Cockcroft JR (2002) Pulse-wave analysis: clinical evaluation of a noninvasive, widely applicable method for assessing endothelial function. Arterioscler Thromb Vasc Biol 22(1):147–152CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Murat Sunbul
    • 1
  • Dilek Seckin
    • 2
  • Erdal Durmus
    • 1
  • Zuleyha Ozgen
    • 2
  • Mehmet Bozbay
    • 1
  • Ayfer Bozbay
    • 3
  • Tarik Kivrak
    • 1
  • Mustafa Oguz
    • 1
  • Ibrahim Sari
    • 1
  • Tulin Ergun
    • 2
  • Mehmet Agirbasli
    • 1
    • 4
  1. 1.Marmara University Faculty of Medicine, Department of CardiologyIstanbulTurkey
  2. 2.Marmara University Faculty of Medicine, Department of DermatologyIstanbulTurkey
  3. 3.Fatih University Faculty of Medicine, Department of DermatologyIstanbulTurkey
  4. 4.Marmara University Education and Research Hospital, Fevzi Cakmak MahallesiIstanbulTurkey

Personalised recommendations