Review article
Psoriasis strikes back! Epicardial adipose tissue: Another contributor to the higher cardiovascular risk in psoriasis
Psoríase contra-ataca! Gordura epicárdica: outro importante contribuidor para o aumento do risco de doença cardiovascular na psoríase
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Epicardial adipose tissue: Another contributor to the higher cardiovascular risk in psoriasis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "613" "paginaFinal" => "616" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Inês Raposo, Tiago Torres" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Inês" "apellidos" => "Raposo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Tiago" "apellidos" => "Torres" "email" => array:1 [ 0 => "torres.tiago@outlook.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Centro Hospitalar do Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unit for Multidisciplinary Research in Biomedicine, Instituto Ciências Biomédicas Abel Salazar, University of Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Psoríase contra-ataca! Gordura epicárdica: outro importante contribuidor para o aumento do risco de doença cardiovascular na psoríase" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A long time ago, in a Medicine far, far away, psoriasis was considered an inflammatory condition restricted to the skin. With increasing knowledge of the immunopathogenesis of psoriasis, it became clear that the disease's inflammatory action went beyond the skin, affecting the individual systemically. A new view of psoriasis was then formulated: the condition formerly viewed as exclusively dermatologic is now considered an immune-mediated, systemic inflammatory disease associated with numerous medical comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Patients with psoriasis present an increased prevalence of cardiometabolic diseases and overall cardiovascular mortality,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> and epidemiologic studies have demonstrated higher prevalence and incidence of cardiovascular risk factors, such as diabetes, dyslipidemia, hypertension and obesity, in these patients.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, these factors are not on their own sufficient to explain the increased risk of cardiovascular disease in psoriasis. The inflammatory pathophysiology of atherosclerosis is mechanistically similar to psoriasis, as atherosclerosis and psoriasis share several cytokines and inflammatory mediators.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Various studies have suggested that psoriasis may be an independent risk factor for atherosclerosis, due to the disease's inflammatory burden, showing that psoriasis itself poses an intrinsic risk for cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However, just when it was thought that the association between psoriasis and cardiovascular disease was explained, psoriasis has produced a surprise once again. It appears that causes other than systemic inflammation and traditional cardiovascular risk factors may be implicated in cardiovascular disease in psoriasis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Epicardial adipose tissue (EAT), a subtype of visceral adipose tissue located between the epicardial layer surrounding the heart and the myocardium, has gained recent clinical attention. EAT is currently considered an active metabolic and inflammatory tissue, with the ability to produce and release various proatherosclerotic and proinflammatory hormones and cytokines, including IL-1 beta, IL-6, TNF-alpha, leptin, plasminogen activator inhibitor-1, and monocyte chemoattractant protein-1.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Its close relation to the coronary tree has been suggested as potentially relevant for the development of coronary artery disease (CAD) by endocrine mechanisms, and particularly by local inflammation and paracrine mechanisms. EAT has been independently associated with CAD, and in the Multi-Ethnic Study of Atherosclerosis it was shown to be predictive of incident cardiovascular events independently of conventional risk factors and body mass index.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Moreover, EAT has been implicated in the development of insulin resistance, diabetes and metabolic syndrome.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Recently, using imaging methods such as transthoracic echocardiography and multidetector computed tomography, EAT has been shown to be increased in psoriatic patients and to be associated with subclinical atherosclerosis, providing another possible link between psoriasis and atherosclerosis.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12</span></a> Interestingly, in one study with 100 severe psoriasis patients and 202 controls, EAT volume was found to be increased in psoriatic patients independently of abdominal visceral fat, a reliable marker of excess visceral adiposity, indicating that there may be some psoriasis-related mechanisms contributing to this increased EAT volume.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The reason for the increase in EAT in patients with psoriasis is unknown, but it is probably the result of multifactorial interaction. The association may be partly explained at a genetic level, due to shared genetic and immune-mediated mechanisms. It has recently been shown that psoriasis patients carrying the minor allele (G) of the IL-6 rs2069840 (C>G) polymorphism have increased EAT volume independently of age, gender and abdominal visceral fat. This effect appeared to be enhanced in homozygosity for the G allele (GG), as these patients had increased EAT volume compared to those carrying the C allele (CC+CG).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The mechanisms by which IL-6 gene polymorphisms influence EAT or overall adiposity are unknown. It is possible that some IL-6 genotypes are associated with lower energy expenditure, providing a possible explanation for an association between certain polymorphisms and long-term weight gain and obesity.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> If the G allele of the IL-6 rs2069840 polymorphism is associated with lower energy expenditure, these subjects might be expected to have more adiposity for the same level of physical activity and calories ingested compared with persons without the G allele. Additionally, there is increasing evidence for the influence of proinflammatory cytokines, particularly IL-6, on excess adiposity.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> IL-6 has been shown to have a role in the pathogenesis of psoriasis, as it is involved in the immunologic cascade that leads to the disease, including the development of Th17 cells from naïve T cells, and the IL-23-induced skin inflammation that cannot occur without its presence.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> It also has a biologic role in the modulation of body fat and obesity, being secreted by adipose tissue, and is involved in atherogenesis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Thus, polymorphisms associated with higher expression of IL-6 may partly explain the association between psoriasis and increased EAT volume. Although the IL-6 rs2069840 polymorphism has not been extensively studied, it has been shown to be associated with higher IL-6 plasma levels.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">On the other hand, the reason for increased EAT independently of overall adiposity may be more difficult to explain. However, a recent study showed that epicardial adipocytes differ substantially from visceral adipocytes, expressing higher levels of IL-6 (8.13-fold, p<0.05) and IL-8 (3.25-fold, p<0.05) and lower levels of the atheroprotective adiponectin compared with visceral preadipocytes.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Thus, it is possible that certain gene polymorphisms present in patients with psoriasis may be associated with localized increases in adipose tissue.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, another possible cause is behavioral. Aerobic exercise training has been shown to be associated with significant reductions in EAT thickness. Psoriatic patients exhibit decreased levels of physical activity, possibly for both psychological and physiological reasons, as the stigmatization and social avoidance usually seen in patients with psoriasis might make adherence to physical activity problematic.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Regarding the clinical applications of these findings, EAT measurement may be used as a simple marker to identify psoriatic patients with higher cardiovascular risk. There are several imaging modalities for measuring EAT.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Although magnetic resonance imaging and computed tomography are currently considered gold standard, echocardiographic measurement of EAT is feasible, reproducible and less expensive and may be a simple and practical tool in clinical practice and research for cardiovascular risk stratification of psoriatic patients.</p><p id="par0045" class="elsevierStylePara elsevierViewall">To summarize, epidemiologic studies have demonstrated that morbidity and mortality in psoriasis are mainly due to cardiovascular disease. Current evidence indicates that along with the increased prevalence of cardiometabolic risk factors and systemic inflammation in psoriasis, EAT is probably another important contributor to the higher cardiovascular risk observed in these patients, with particular importance due to the local effect on the myocardial vasculature. For this reason, it can be said that EAT may be another “Death Star” in psoriasis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Protection of human and animal subjects</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Confidentiality of data</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Right to privacy and informed consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres817823" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec814936" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres817822" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec814937" "titulo" => "Palavras-chave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-20" "fechaAceptado" => "2015-04-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec814936" "palabras" => array:5 [ 0 => "Atherosclerosis" 1 => "Cardiovascular disease" 2 => "Cardiovascular risk" 3 => "Epicardial adipose tissue" 4 => "Psoriasis" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec814937" "palabras" => array:6 [ 0 => "Aterosclerose" 1 => "Doença cardiovascular" 2 => "Gordura epicárdica" 3 => "Psoríase" 4 => "Risco cardiovascular" 5 => "Tecido adiposo epicárdico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">For many years psoriasis was considered an inflammatory condition restricted to the skin. However, nowadays it is considered an immune-mediated, systemic inflammatory condition associated with numerous medical comorbidities, particularly cardiometabolic diseases, and overall cardiovascular mortality. Several studies have suggested that psoriasis may be an independent risk factor for atherosclerosis, indicating that psoriasis itself poses an intrinsic risk for cardiovascular disease, probably due to the disease's inflammatory burden. However, other causes beyond systemic inflammation and traditional cardiovascular risk factors may be implicated in cardiovascular disease in psoriasis. Recently, epicardial adipose tissue, an emerging cardiovascular risk factor, has been shown to be increased in psoriasis patients and to be associated with subclinical atherosclerosis, providing another possible link between psoriasis and atherosclerosis. The reason for the increase in epicardial adipose tissue in patients with psoriasis is unknown, but it is probably multifactorial, with genetic, immune-mediated and behavioral factors having a role.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thus, along with the increased prevalence of cardiometabolic risk factors and systemic inflammation in psoriasis, epicardial adipose tissue is probably another important contributor to the higher cardiovascular risk observed in psoriasis.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A psoríase foi considerada durante muitos anos uma doença inflamatória exclusivamente cutânea. No entanto, hoje em dia, a psoríase é considerada uma doença inflamatória sistémica, imuno-mediada, associada a diversas comorbilidades, em particular cardiometabólicas, e a um aumento da mortalidade cardiovascular. Vários estudos apontam que a psoríase, por si só, apresenta um risco intrínseco de doença cardiovascular, provavelmente relacionado com a inflamação sistémica, representando um fator de risco independente de aterosclerose. Contudo, outras causas para além da inflamação sistémica e dos fatores de risco cardiovasculares tradicionais poderão estar implicados no desenvolvimento de doença cardiovascular na psoríase. Recentemente, a gordura epicárdica, demonstrou estar aumentada em doentes com psoríase, e associar-se a aterosclerose subclínica, providenciando outra possível explicação para a ligação entre a psoríase e aterosclerose. A razão pela qual a gordura epicárdica se encontra aumentada em doentes com psoríase é ainda desconhecida, mas será provavelmente multifatorial, com fatores genéticos, imunológicos, e comportamentais a desempenharem um papel.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Assim, juntamente com o aumento da prevalência de fatores de risco cardiovasculares tradicionais e a inflamação sistémica psoriática, a gordura epicárdica é provavelmente outro importante contribuidor para o maior risco cardiovascular observado nos doentes com psoríase.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The concept of psoriasis as a systemic inflammation: implications for disease management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. 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| Year/Month | Html | Total | |
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| 2024 November | 2 | 3 | 5 |
| 2024 October | 31 | 36 | 67 |
| 2024 September | 42 | 24 | 66 |
| 2024 August | 40 | 34 | 74 |
| 2024 July | 29 | 31 | 60 |
| 2024 June | 37 | 31 | 68 |
| 2024 May | 32 | 19 | 51 |
| 2024 April | 32 | 22 | 54 |
| 2024 March | 26 | 27 | 53 |
| 2024 February | 29 | 43 | 72 |
| 2024 January | 25 | 38 | 63 |
| 2023 December | 19 | 25 | 44 |
| 2023 November | 25 | 17 | 42 |
| 2023 October | 24 | 22 | 46 |
| 2023 September | 22 | 16 | 38 |
| 2023 August | 18 | 20 | 38 |
| 2023 July | 22 | 17 | 39 |
| 2023 June | 18 | 9 | 27 |
| 2023 May | 31 | 26 | 57 |
| 2023 April | 9 | 4 | 13 |
| 2023 March | 24 | 22 | 46 |
| 2023 February | 22 | 22 | 44 |
| 2023 January | 18 | 7 | 25 |
| 2022 December | 25 | 19 | 44 |
| 2022 November | 37 | 26 | 63 |
| 2022 October | 29 | 17 | 46 |
| 2022 September | 29 | 30 | 59 |
| 2022 August | 31 | 44 | 75 |
| 2022 July | 31 | 34 | 65 |
| 2022 June | 11 | 16 | 27 |
| 2022 May | 21 | 25 | 46 |
| 2022 April | 26 | 32 | 58 |
| 2022 March | 16 | 31 | 47 |
| 2022 February | 9 | 17 | 26 |
| 2022 January | 22 | 26 | 48 |
| 2021 December | 14 | 27 | 41 |
| 2021 November | 32 | 40 | 72 |
| 2021 October | 35 | 46 | 81 |
| 2021 September | 19 | 24 | 43 |
| 2021 August | 35 | 25 | 60 |
| 2021 July | 19 | 19 | 38 |
| 2021 June | 23 | 14 | 37 |
| 2021 May | 25 | 40 | 65 |
| 2021 April | 38 | 41 | 79 |
| 2021 March | 46 | 24 | 70 |
| 2021 February | 42 | 15 | 57 |
| 2021 January | 25 | 10 | 35 |
| 2020 December | 33 | 12 | 45 |
| 2020 November | 31 | 20 | 51 |
| 2020 October | 14 | 18 | 32 |
| 2020 September | 50 | 10 | 60 |
| 2020 August | 18 | 8 | 26 |
| 2020 July | 44 | 12 | 56 |
| 2020 June | 30 | 10 | 40 |
| 2020 May | 37 | 5 | 42 |
| 2020 April | 41 | 17 | 58 |
| 2020 March | 41 | 21 | 62 |
| 2020 February | 65 | 51 | 116 |
| 2020 January | 17 | 5 | 22 |
| 2019 December | 30 | 6 | 36 |
| 2019 November | 18 | 11 | 29 |
| 2019 October | 31 | 6 | 37 |
| 2019 September | 19 | 15 | 34 |
| 2019 August | 32 | 4 | 36 |
| 2019 July | 26 | 6 | 32 |
| 2019 June | 25 | 11 | 36 |
| 2019 May | 32 | 9 | 41 |
| 2019 April | 23 | 14 | 37 |
| 2019 March | 33 | 14 | 47 |
| 2019 February | 53 | 10 | 63 |
| 2019 January | 77 | 6 | 83 |
| 2018 December | 52 | 10 | 62 |
| 2018 November | 141 | 14 | 155 |
| 2018 October | 314 | 15 | 329 |
| 2018 September | 53 | 10 | 63 |
| 2018 August | 24 | 6 | 30 |
| 2018 July | 46 | 10 | 56 |
| 2018 June | 49 | 8 | 57 |
| 2018 May | 68 | 11 | 79 |
| 2018 April | 51 | 3 | 54 |
| 2018 March | 48 | 7 | 55 |
| 2018 February | 102 | 0 | 102 |
| 2018 January | 121 | 8 | 129 |
| 2017 December | 212 | 11 | 223 |
| 2017 November | 41 | 11 | 52 |
| 2017 October | 26 | 14 | 40 |
| 2017 September | 24 | 8 | 32 |
| 2017 August | 18 | 8 | 26 |
| 2017 July | 22 | 9 | 31 |
| 2017 June | 23 | 4 | 27 |
| 2017 May | 29 | 6 | 35 |
| 2017 April | 18 | 6 | 24 |
| 2017 March | 26 | 30 | 56 |
| 2017 February | 23 | 8 | 31 |
| 2017 January | 26 | 6 | 32 |
| 2016 December | 32 | 8 | 40 |
| 2016 November | 24 | 2 | 26 |
| 2016 October | 32 | 4 | 36 |
| 2016 September | 29 | 7 | 36 |
| 2016 August | 15 | 4 | 19 |
| 2016 July | 15 | 3 | 18 |
| 2016 June | 12 | 2 | 14 |
| 2016 May | 22 | 3 | 25 |
| 2016 April | 11 | 6 | 17 |
| 2016 March | 12 | 9 | 21 |
| 2016 February | 15 | 11 | 26 |
| 2016 January | 24 | 10 | 34 |
| 2015 December | 11 | 6 | 17 |
| 2015 November | 30 | 10 | 40 |
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