Levels of Asymmetric Dimethylarginine (ADMA) and High Sensitive C-Reactive Protein (hsCRP) in Patients with Psoriasis

Abstract

Aim: Asymmetric dimethylarginine (ADMA) is a major inhibitor of nitric oxide synthesis inhumans. Recent reports have demonstrated that elevated high sensitive C-reactive protein(hsCRP), an inflammatory marker, and plasma ADMA levels are associated with endothelialdysfunction and increased atherogenesis. We aimed to determine the presence of endothelialdysfunction in psoriatic patients and if psoriazis is an independent risk factor for cardiovasculardiseases by measuring the serum levels of ADMA and hsCRP in patients with psoriazis.Material and Methods: Thirty five psoriatic patients not having traditional cardiovascular riskfactors and 26 healthy controls were included into the study. Serum levels of ADMA, hsCRP,HDL, LDL, triglyceride, and total cholesterol, and BMI analyses were assessed and comparedbetween patient and control subjects. The association of psoriazis area and severity index (PASI)scores with ADMA and hsCRP levels were evaluated. Results: There was no statistically significant difference for the demographic characteristics,and all laboratory parameters levels between psoriazis and control groups. ADMA values were0.63±0.30 μmol/L (mean±sd) and 0.68±0.45 μmol/L (mean±sd) in patients and control group,respectively. hsCRP levels were 1.40±1.51 mg/L (mean±sd) in control group, while 1.91±2.13mg/L (mean±sd) in patients group. There was no statistically significant difference betweenpatients and control groups, in terms of ADMA and hsCRP values (p>0.05). Statisticallysignificance and moderate correlation was found between PASI scores and serum hsCRP levels(r=0,73; p

Keywords

• asymmetric dimethylarginine,comorbidity,psoriazis,high sensitive C-reactive protein

PSORİAZİSLİ HASTALARDA SERUM ASİMETRİK DİMETİLARJİNİN (ADMA) VE YÜKSEK SENSİTİF C-REAKTİF PROTEİN (hsCRP) SEVİYELERİ

Abstract

Amaç: Asimetrik dimetilarjinin (ADMA) nitrik oksit sentezinin major inhibitörüdür. SerumADMA ve inflamatuar bir belirteç olan yüksek sensitif C reaktif protein (hsCRP) düzeylerindekiartışın endotel disfonksiyonu ve artmış aterogenez ile ilişkili olduğu gösterilmiştir. Bu çalışmadaplak psoriazis hastalarında ADMA ve hsCRP serum seviyelerini ölçerek hastalarda endotelyaldisfonksiyon varlığını belirlemeyi ve psoriazisin kendisinin kardiyovasküler hastalıklar içinbağımsız bir risk faktörü olup olmadığını tespit etmeyi amaçladık.Gereç ve Yöntem: Çalışmaya geleneksel kardiyovasküler risk faktörü taşımayan 35 psoriazislihasta ve 26 gönüllü kontrol dahil edildi. Hasta ve kontrol gruplarının serum ADMA, hsCRP,HDL, LDL, trigliserid, total kolesterol düzeyleri ve VKİ değerlendirildi ve karşılaştırıldı.Psoriazis alan şiddet indeksi (PAŞİ) skoru ile ADMA düzeyleri ve hsCRP arasındaki ilişkideğerlendirildi.Bulgular: Hasta ve kontrol grubu arasında demografik özellikler ve tüm laboratuvarparametrelerinin düzeyleri arasında istatistiksel anlamlı farklılık yoktu. ADMA değerleri hastagrubunda 0,63±0,30 μmol/L (ort±sd), kontrol grubunda ise 0,68±0,45 μmol/L (ort±sd) olaraktespit edildi. hsCRP düzeyleri hasta grubunda 1,91±2,13 mg/L (ort±sd) iken kontrol grubunda1,40±1,51 mg/L (ort±sd) idi. ADMA ve hsCRP değerleri açısından hasta ve kontrol grubuarasında istatistiksel olarak anlamlı bir farklılık bulunamadı (p>0,05). PAŞİ skorları ile hsCRPdüzeyleri arasında anlamlılık ve orta derecede pozitif korelasyon saptandı (r=0,73; p

Keywords

• Asimetrik dimetilarjinin,komorbidite,psoriazis,yüksek sensitif C reaktifprotein

References

1. Christophers E, Mrowietz U: Psoriazis. In Braun-Falco, Plewig G, Wollf HH, Landthaler M eds: Braun-Falco’s Dermatology. Third ed. Heidelberg. Springer Medizin Verlag. pp: 506-26, 2009
2. Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, Giannetti A, Girolomoni G. Prevalence of metabolic syndrome in patients with psoriazis: a hospital- based case-control study. Br J Dermatol. 2007;157:68-73.
3. Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriazis. Arch Dermatol Res. 2006;298:321-328.
4. Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriazis. J Am Acad Dermatol. 2006;55:829- 835.
5. Shapiro J, Cohen AD, David M, Hodak E, Chodik G, Viner A, Kremer E, Heymann A. The association between psoriazis, diabetes mellitus, and atherosclerosis in Israel: a case-control study. J Am Acad Dermatol. 2007;56:629-634.
6. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriazis. JAMA. 2006;296:1735-1741.
7. Deanfield J, Donald A, Ferri C, Giannattasio C, Halcox J, Halligan S, Lerman A, Mancia G, Oliver JJ, Pessina AC, Rizzoni D, Rossi GP, Salvetti A, Schiffrin EL, Taddei S, Webb DJ; Working Group on Endothelin and Endothelial Factors of the European Society of Hypertension. Endothelial function and dysfunction. Part I: Methodological issues for assessment in the different vascular beds: a statement by the Working Group on Endothelin and Endothelial Factors of the European Society of Hypertension. J Hypertens. 2005;23:7-17.
8. Siekmeier R, Grammer T, März W. Roles of oxidants, nitric oxide, and asymmetric dimethylarginine in endothelial function. J Cardiovasc Pharmacol Ther 2008;13:279-297.

9. Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation. 2001;103:1813-1818.
10. Jialal I, Devaraj S. Inflammation and atherosclerosis: the value of the high-sensitivity C-reactive protein assay as a risk marker. Am J Clin Pathol. 2001;116:108-115.
11. Wever RM, Lüscher TF, Cosentino F, Rabelink TJ. Atherosclerosis and the two faces of endothelial nitric oxide synthase. Circulation. 1998;97:108-112.
12. Langley RG, Krueger GG, Griffiths CE. Psoriazis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64:18-23.
13. Henseler T, Christophers E. Disease concomitance in psoriazis]. J Am Acad Dermatol 1995;32(6):982-6.
14. Kimhi O, Caspi D, Bornstein NM, Maharshak N, Gur A, Arbel Y, Comaneshter D, Paran D, Wigler I, Levartovsky D, Berliner S, Elkayam O. Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin Arthritis Rheum. 2007;36:203-209.
15. Usta M, Yurdakul S, Aral H, Turan E, Oner E, Inal BB, Oner FA, Gurel MS, Guvenen G. Vascular endothelial function assessed by a noninvasive ultrasound method and serum asymmetric dimethylarginine concentrations in mild-to- moderate plaque-type psoriatic patients. Clin Biochem. 2011;44:1080-1084.
16. Atzeni F, Sarzi-Puttini P, Sitia S, Tomasoni L, Gianturco L, Battellino M, Boccassini L, De Gennaro Colonna V, Marchesoni A, Turiel M. Coronary flow reserve and asymmetric dimethylarginine levels: new measurements for identifying subclinical atherosclerosis in patients with psoriatic arthritis. J Rheumatol. 2011;38:1661-1664.
17. Sergeant A, Makrygeorgou A, Chan WC, Thorrat A, Burden D. C-reactive protein in psoriazis. Br J Dermatol. 2008;158:417-419.
18. Strober B, Teller C, Yamauchi P, Miller JL, Hooper M, Yang YC, Dann F. Effects of etanercept on C-reactive protein levels in psoriazis and psoriatic arthritis. Br J Dermatol. 2008;159:322-330.
19. Balcı DD, Yönden Z Doğramacı ÇA, Duran N. Serum High Sensitivity C Reactive Protein and Homocysteine Levels in Patients with Mild to Moderate Psoriazis. Türkderm 2009;43:53-57.
20. Olsen MH, Christensen MK, Hansen TW, Gustafsson F, Rasmussen S, Wachtell K, Borch-Johnsen K, Ibsen H, Jİrgensen T, Hildebrandt P. High-sensitivity C-reactive protein is only weakly related to cardiovascular damage after adjustment for traditional cardiovascular risk factors. J Hypertens. 2006;24:655-661.