Original article
Elevated plasma osteopontin level is associated with occurrence of psoriasis and is an unfavorable cardiovascular risk factor in patients with psoriasis

https://doi.org/10.1016/j.jaad.2008.09.046Get rights and content

Background

The association between psoriasis and cardiovascular diseases is well documented yet the underlying mechanisms remain elusive.

Objectives

We sought to study the role of circulating osteopontin (OPN) in the pathogenesis of cardiovascular diseases in patients with psoriasis.

Methods

Plasma samples from 40 patients with psoriasis and 37 control subjects were collected for enzyme-linked immunosorbent assays. The clinical significance of OPN levels in patients with psoriasis versus control subjects was analyzed using the Mann-Whitney U test and logistic regression. DNA samples from 268 patients with psoriasis and 146 control subjects were collected for genotyping of the OPN gene.

Results

Higher body mass index values (P = .047) and hypertension (odds ratio [OR] 2.68, P = .05) were observed in patients with psoriasis. Increased plasma OPN levels (≥62.95 ng/mL) were significantly associated with psoriasis (OR 6.24, P = .001), hypertension (OR 3.05, P = .03), and diabetes mellitus (OR 3.13, P = .05). Occurrence of psoriasis (OR 5.12, P = .003) appeared to be the single independent risk factor for high plasma OPN values after multivariate logistic regression. Among patients with psoriasis, increased plasma OPN values were associated with the presence of hypertension (OR 4.69, P = .05). However, no significantly different allelic distributions of single nucleotide polymorphisms of the OPN gene were found between psoriasis and control groups.

Limitations

The number of patients evaluated was relatively small.

Conclusions

High plasma OPN levels are an unfavorable factor for development of cardiovascular disease in patients with psoriasis.

Section snippets

Patients

From January 2006 to January 2007, blood samples from 40 patients with psoriasis vulgaris with moderate to severe involvement were obtained via the outpatient department of dermatology in our veterans' general hospitals. Clinical parameters including age, sex, body weight, height, phenotype of psoriasis, psoriasis severity score at enrollment, presence of psoriatic arthritis, and presence of comorbidities including hypertension, ischemic heart disease, diabetes, and dyslipidemia were collected.

Epidemiologic data between control subjects and patients with psoriasis

A total of 40 plasma samples from psoriasis and 37 plasma samples from age- and sex-matched control subjects were enrolled and analyzed. There were no significant differences in age and sex between the two groups. Significantly more hypertension (odds ratio [OR] 2.68, P = .05) and higher BMI values (25.35 ± 0.75 vs 23.81 ± 0.56 kg/m2, P = .047) were observed in patients with psoriasis than in control subjects (Table I). More patients with diabetes (OR 2.49, P = .10) and MetS (OR 2.40, P = .18)

Discussion

Although the cardiovascular complications of psoriasis have been well documented in several epidemiologic studies, the mechanisms of these comorbidities remain unclear. In addition to traditional cardiovascular risk factors commonly seen in psoriasis, including obesity, hypertension, diabetes, hyperlipidemia, and smoking,4, 5, 6, 7 other unfavorable factors have been proposed. Dysregulation of cytokines such as interleukin 1 and tumor necrosis factor-α have been reported in psoriasis,

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      Immunohistochemical staining of psoriatic plaque biopsies revealed that OPN is highly expressed by keratinocytes, endothelial cells and immune infiltrating cells, including CD1a+ DC and effector T lymphocytes [86]. Moreover, increased OPN plasma levels was found associated with psoriasis [90]. Based on this evidence, it was proposed that, in genetic susceptibility conditions, the expression of OPN, triggered by bacteria or trauma, may enhance DC/LC migration and Th1 polarization.

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    Supported by Taichung Veterans General Hospital research grants (TCVGH-956802B, TCVGH-9546801A, 2006 and TCVGH-966801A, 2007).

    Conflicts of interest: None declared.

    Dr Y-J. Chen and Dr Shen contributed equally to this work.

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