Assessor-Blinded Study of the Metabolic Syndrome and Surrogate Markers of Increased Cardiovascular Risk in Children With Moderate-to-Severe Psoriasis Compared With Age-Matched Population of Children With Warts
August 2011 | Volume 10 | Issue 8 | Original Article | 900 | Copyright © 2011
Eva M. Volf MD,a Danielle E. Levine MD,a Melissa A. Michelon MD,a Shiu-Chung Au MD,b Eshan Patvardhan MD,b Nicole Dumont,b Daniel S. Loo MD,b Jeffrey Kuvin MD,a,b Alice B. Gottlieb MD PhDa,b
aTufts University School of Medicine, Boston, MA bDepartment of Dermatology, Tufts Medical Center, Boston, MA
Adult patients with psoriasis have an increased prevalence of the metabolic syndrome (MetS) and cardiovascular disease (CVD) risk factors due to elevations of Tumor Necrosis Factor and other inflammatory cytokines.1,2 Recently, higher rates of hyperlipidemia, obesity, hypertension, and diabetes mellitus were seen in patients with juvenile psoriasis.3 Here, we report the interim results of an ongoing study of MetS and CVD risk factors in pediatric psoriasis patients.
J Drugs Dermatol. 2011;10(8):903-904.
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This trial was an investigator-initiated assessor blinded study of MetS and surrogate markers of increased CVD risk in pediatric psoriasis patients versus a control group of patients with warts. Our study included twenty children, ages 10 to 17 with moderate-to-severe psoriasis compared to twenty age- and sex-matched controls. All patients provided written informed consent before entering the study and the protocol was approved by the Institutional Review Board at Tufts Medical Center. Baseline demographics are depicted in Table 1. Patients with psoriasis had plaques that covered greater than 5% body surface area or a documented history of body surface area of at least 5%. Psoriasis patients were permitted to use any topical, systemic, or biologic agent throughout the trial. MetS was defined by the presence of three of the following criteria: triglycerides ≥100 mg/dl, HDL-C <50 mg/dl for females or <45 mg/dl males, fasting blood glucose ≥110 mg/dl, waist circumference >75th percentile for age and sex, systolic or diastolic blood pressure >90th percentile for age, sex and height.4 Fasting glucose and serum lipid profiles were obtained after a 12-hour fast.
Preliminary results outlined in Table 2 of 18 enrolled children showed that patients with psoriasis had lower mean HDL-C levels, 41.7 mg/dl versus 53.8 mg/dl in the control group (P=0.048).
LDL-C, triglycerides and fasting glucose were not statistically different between the two groups. One-third of pediatric psoriasis patients (four out of 12 patients) met criteria for MetS versus no children in the control group (P=0.245), shown in Figure 1. Analysis on completion of the study may yield a statistically significant incidence of MetS in psoriasis patients. These interim results suggest that children with psoriasis may have an increased risk for CVD and MetS. It may be important to screen pediatric psoriasis patients for these risk factors earlier than current recommended guidelines.