Advertisement

Archives of Dermatological Research

, Volume 311, Issue 4, pp 287–297 | Cite as

Malondialdehyde, lipoprotein-a, lipoprotein ratios, comprehensive lipid tetrad index and atherogenic index as surrogate markers for cardiovascular disease in patients with psoriasis: a case–control study

  • Dhaarna Wadhwa
  • Vikram K. MahajanEmail author
  • Karaninder S. Mehta
  • Pushpinder S. Chauhan
  • Rajinder S. Yadav
  • Satya Bhushan
  • Vikas Sharma
  • Anuj Sharma
  • Aditi Sharma
  • Shailja Chauhan
Original Paper
  • 64 Downloads

Abstract

Psoriasis is now recognized as an immune-mediated inflammatory dermatosis with increased risk for metabolic syndrome, its individual components, and cardiovascular disease. We quantitatively estimated malondialdehyde (MDA), lipoprotein-a (LP-a), lipoprotein ratios, comprehensive lipid tetrad index (CLTI), and atherogenic index (AI), and evaluated cardiovascular risk in 132 (M:F 94:38) patients with psoriasis aged 20–79 years with chronic plaque psoriasis and equal number of age and gender-matched controls. Lipoprotein ratios, CLTI and AI were calculated using standard formulae. Cardiovascular 10-year risk was graded by Framingham risk score (FRS) as low, intermediate and severe. Mild-to-moderate and severe psoriasis was present in 125 (94.7%), and 7 (5.3%) patients, respectively, and 19 (14.39%) patients had psoriatic arthritis. Statistically significant differences were noted for LDL, LDL/HDL, non-HDL/HDL, MDA, LP-a, AI and CLTI. There was a significantly positive correlation between PASI with LP-a (p = 0.003, r = 0.25) and AI (p = 0.012, r = 0.22). Serum levels of MDA correlated positively with LP-a (p < 0.001, r = 0.55), AI (p < 0.001, r = 0.51) and CLTI (p = 0.006, r = 0.24). FRS was low, intermediate and severe in 78%, 18.9%, and 3% patients compared to 85.6%, 13.6%, and 0.8% controls, respectively, and the difference was not statistically significant. Psoriasis appears to be an independent risk factor for elevated serum MDA, LP-a, CLTI and AI. However, whether they can be used as surrogate markers for enhanced cardiovascular risk in patients with psoriasis, remains conjectural.

Keywords

Cardiovascular disease risk Dyslipidemia Framingham risk score Metabolic syndrome Oxidative stress Psoriasis 

Abbreviations

LDL

Low-density lipoprotein

LP-a

Lipoprotein-a

HDL

High-density lipoprotein

VLDL

Very low-density lipoprotein

MDA

Malondialdehyde

AI

Atherogenic index

CLTI

Comprehensive lipid tetrad index

BMI

Body mass index

FR

Framingham risk

PASI

Psoriasis area severity index

CRP

C-reactive protein

ROS

Reactive oxygen species

Notes

Acknowledgements

Mr. Ramesh Chand Goel (MSc.), former Biostatistician, Post Graduate Institute of Medical Education and Research, Chandigarh (India), helped in statistical analysis of the data. His erudite association throughout the study is gratefully acknowledged. The authors also thank their patients/subjects who volunteered for the study.

Author contributions

DW obtained compiled, analyzed all data and prepared the initial draft. VKM analyzed and interpreted data, drafted, and critically evaluated the manuscript for important intellectual content. RSY and SB provided intellectual help in investigative study and interpretation of biochemistry results. KSM, PSC, VS, AS, AS, and SC helped in obtaining, compiling and interpretation of data and literature search. All the authors were involved in the revision of the draft manuscript and have agreed to the final content.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no competing interest and, therefore, nothing else to declare, and have contributed significantly and take full responsibility for the manuscript. The authors of the paper are obliged to confirm that it has not been previously published. The study was not funded by any agency. The clinical data form part of the thesis submitted to Himachal Pradesh University, Shimla, (H.P.) for the degree of M.D. (DVL.).

Statement of ethics

The study was approved by Institutional Scientific Protocol Review Committee and Institutional Ethics Committee (Rgn no ECR/490/Inst/HP/2013/RR-16). Informed consent was obtained from all the patients for being enrolled in the study. All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

References

  1. 1.
    Akkara Veetil BM, Matteson EL, Maradit-Kremers H, McEvoy MT, Crowson CS (2012) Trends in lipid profile in patients with psoriasis: a population based analysis. BMC Dermatol 12:20CrossRefGoogle Scholar
  2. 2.
    American Diabetes Association (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33(suppl 1):S62–S69CrossRefGoogle Scholar
  3. 3.
    Ashok V, Divya R, Karthikeyan K (2016) A study of correlation between serum malondialdehyde and the clinical severity of psoriasis. J Evid Based Med Healthc 3:1086–1088CrossRefGoogle Scholar
  4. 4.
    Attwa E, Swelam E (2011) Relationship between smoking-induced oxidative stress and the clinical severity of psoriasis. J Eur Acad Dermatol Venereol 25:782–787CrossRefGoogle Scholar
  5. 5.
    Baweja P, Agarwal BK, Sharma VK, Alex A (2013) Oxidant and antioxidant status in patients with psoriasis. Indian J Appl Pure Biol 28:143–148. http://biology-journal.org/journal.php?p=152
  6. 6.
    Burman A, Jain K, Gulati R, Chopra V, Agarwal DP, Vasisht S (2004) Lipoprotein(a) as a marker of coronary artery disease and its association with dietary fat. J Assoc Physicians India 52:99–102Google Scholar
  7. 7.
    Cozzani E, Rosa G, Burlando M, Parodi A (2018) Psoriasis as a cardiovascular risk factor: updates and algorithmic approach. G Ital Dermatol Venereol 153:659–665Google Scholar
  8. 8.
    Das B, Daga MK, Gupta SK (2007) Lipid Pentad Index: a novel bioindex for evaluation of lipid risk factors for atherosclerosis in young adolescents and children of premature coronary artery disease patients in India. Clin Biochem 40:18–24CrossRefGoogle Scholar
  9. 9.
    National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) (2002) Third report of the National Cholesterol Education Program (NCEP). Circulation 106:3143–3421Google Scholar
  10. 10.
    Ferretti G, Bacchetti T, Campanati A, Simonetti O, Liberati G, Offidani A (2012) Correlation between lipoprotein(a) and lipid peroxidation in psoriasis: role of the enzyme paraoxonase-1. Br J Dermatol 166:204–207CrossRefGoogle Scholar
  11. 11.
    Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112:2735–2752CrossRefGoogle Scholar
  12. 12.
    Gupta M, Chari S, Borkar M, Chandankhede M (2011) Dyslipidemia and oxidative stress in patients of psoriasis. Biomed Res 22:222–225. https://pdfs.semanticscholar.org/2165/a012a1fa7655954120f50be80b8e445e6040.pdf
  13. 13.
    Helliwell PS, Taylor WJ (2005) Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis 64:ii3–ii8CrossRefGoogle Scholar
  14. 14.
    Jyothi RS, Govindswamy KS, Gurupadappa K (2011) Psoriasis: an oxidative stress condition. J Clin Diagn Res 5:252–253. http://www.jcdr.net/article_fulltext.asp?id=1247
  15. 15.
    Kadam DP, Suryakar AN, Ankush RD, Kadam CY, Deshpande KH (2010) Role of oxidative stress in various stages of psoriasis. Indian J Clin Biochem 25:388–392CrossRefGoogle Scholar
  16. 16.
    Kumawat M, Sharma TK, Singh I, Singh N, Ghalaut VS, Vardey SK et al (2013) Antioxidant enzymes and lipid peroxidation in type 2 diabetes mellitus patients with and without nephropathy. N Am J Med Sci 5:213CrossRefGoogle Scholar
  17. 17.
    Latha MM, Bhaskar MV, Preethi AS, Priyanka M, Srilakshmi P (2015) Status of serum lipids and oxidative stress in psoriatic cases. Int J Med Health Sci 4:337–340. http://www.ijmhs.net/articles/1436580
  18. 18.
    Loo SKF, Yeung KH, Ho KM, Loo KK (2010) Cardiovascular comorbidities in psoriasis. Hong Kong J Dermatol Venereol 18:72–81. http://medcomhk.com/hkdvb/pdf/2010v18n02-03.pdf
  19. 19.
    Morais CA, Oliveira SH, Lima LM (2013) Lipid tetrad index (LTI) and lipid pentad index (LPI) in healthy subjects. Arg Bras Cardiol 100:322–327Google Scholar
  20. 20.
    Nassiri S, Malekzad F, Sarlak M, Saeedi M, Hedayati M, Qaisari M (2009) Interplay among antioxidants and oxidants in psoriasis. Iranian J Dermatol 12:56–59. http://www.iranjd.ir/download.asp?code=IJD09124856
  21. 21.
    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 55:829–835CrossRefGoogle Scholar
  22. 22.
    Nemati H, Khodarahmi R, Rahmani A, Ebrahimi A, Amani M, Eftekhari K (2013) Serum lipid profile in psoriatic patients: correlation between vascular adhesion protein-1 and lipoprotein (a). Cell Biochem Funct 31:36–40CrossRefGoogle Scholar
  23. 23.
    Ng CY, Tzeng I-S, Liu S-H, Chang Y-C, Huang Y-H (2018) Metabolic parameters in psoriatic patients treated with interleukin-12/23 blockade (ustekinumab). J Dermatol 45:309–313CrossRefGoogle Scholar
  24. 24.
    Nordestgaard BG, Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF et al (2010) Lipoprotein (a) as a cardiovascular risk factor: current status. Eur Heart J 31:2844–2853CrossRefGoogle Scholar
  25. 25.
    Peluso I, Cavaliere A, Palmery M (2016) Plasma total antioxidant capacity and peroxidation biomarkers in psoriasis. J Biomed Sci 23:1–13CrossRefGoogle Scholar
  26. 26.
    Pietrzak A, Kadzielewski J, Janowski K, Roliński J, Krasowska D, Chodorowska G et al (2009) Lipoprotein (a) in patients with psoriasis: associations with lipid profiles and disease severity. Int J Dermatol 48:379–387CrossRefGoogle Scholar
  27. 27.
    Pietrzak A, Michalak-Stoma A, Chodorowska G, Sczpietowski JC (2010) Lipid disturbance in psoriasis: an update. Mediat Inflamm 2010:535612.  https://doi.org/10.1155/2010/535612 CrossRefGoogle Scholar
  28. 28.
    Poudyal Y, Rajbhandari SL (2014) Lipid profile in psoriasis. J Univers Coll Med Sci 2:16–19CrossRefGoogle Scholar
  29. 29.
    Rajappa M, Shridhar MG, Balachander J, Sethuraman KR (2006) Lipoprotein (a) and comprehensive lipid tetrad index as a marker of coronary artery disease in NIDDM patients in South India. Clin Chim Acta 372:70–75CrossRefGoogle Scholar
  30. 30.
    Senthilkumari S, Sasivathanam N, Ramadevi M, Thangavelu K (2016) Is lipid tetrad index a promising atherogenic index in acute coronary syndrome? Int J Sci Study 4:73–77. https://www.ijss-sn.com/uploads/2/0/1/5/20153321/ijss_nov_oa16_-_2016.pdf
  31. 31.
    Shahzad F (2012) Malondialdehyde: an efficient marker of target organ dysfunction in hypertension. J Med Res Pract 1:76–79Google Scholar
  32. 32.
    Shrestha A, Bahce-Altuntas A, Mowrey W, Broder A (2016) Active peripheral inflammation is associated with pro-atherogenic lipid profile in psoriatic arthritis. Semin Arthritis Rheum 46:286–290CrossRefGoogle Scholar
  33. 33.
    Sikar Aktürk A, Özdoğan HK, Bayramgürler D, Çekmen MB, Bilen N, Kiran R (2012) Nitric oxide and malondialdehyde levels in plasma and tissue of psoriasis patients. J Eur Acad Dermatol Venereol 26:833–837CrossRefGoogle Scholar
  34. 34.
    Singh Y, Srivastava S, Ahmad S, Mishra SK, Shirazi N, Raja M et al (2010) Is lipid tetrad index the strongest predictor of premature coronary artery disease in North India? J India Acad Clin Med 11:175–179. http://medind.nic.in/jac/t10/i3/jact10i3p175.pdf
  35. 35.
    Singla S, Kaur K, Kaur G, Kaur H, Kaur J, Jaswal S (2009) Lipoprotein (a) in type 2 diabetes mellitus: relation to LDL:HDL ratio and glycemic control. Int J Diabetes Dev Ctries 29:80–84CrossRefGoogle Scholar
  36. 36.
    Sunitha S, Rajappa M, Thappa DM, Chandrashekar L, Munisamy M, Revathy G et al (2015) Comprehensive lipid tetrad index, atherogenic index and lipid peroxidation: surrogate markers for increased cardiovascular risk in psoriasis. Indian J Dermatol Venereol Leprol 81:464–471CrossRefGoogle Scholar
  37. 37.
    Thomas J, Kumar NA, Manoharon D, Cynthia S, Selva Prabhu SK, Ahmad NA (2009) A study of comorbid conditions in psoriasis. J Pak Assoc Dermatol 19:200–202. http://www.jpad.com.pk/index.php/jpad/article/view/544
  38. 38.
    Vanizor Kural B, Örem A, Çimşit G, Yandi YE, Calapoǧlu M (2003) Evaluation of the atherogenic tendency of lipids and lipoprotein content and their relationships with oxidant–antioxidant system in patients with psoriasis. Clin Chim Acta 328:71–82CrossRefGoogle Scholar
  39. 39.
    Wakkee M, Thio H, Prens E, Sijbrands E, Neumann H (2007) Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients. Atherosclerosis 190:1–9CrossRefGoogle Scholar
  40. 40.
    Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97:1837–1847CrossRefGoogle Scholar
  41. 41.
    World Health Organizations (2000) The Asia Pacific perspective: redefining obesity and its treatment. Health Communications Australia, SydneyGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Dhaarna Wadhwa
    • 1
  • Vikram K. Mahajan
    • 1
    Email author
  • Karaninder S. Mehta
    • 1
  • Pushpinder S. Chauhan
    • 1
  • Rajinder S. Yadav
    • 2
  • Satya Bhushan
    • 2
  • Vikas Sharma
    • 1
  • Anuj Sharma
    • 1
  • Aditi Sharma
    • 1
  • Shailja Chauhan
    • 1
  1. 1.Department of Dermatology, Venereology and LeprosyDr. R. P. GovKangrat. Medical College(Tanda)India
  2. 2.Department of BiochemistryDr. R. P. Govt. Medical College(Tanda)India

Personalised recommendations