Int J Biol Med Res.

2023 ;14(3):7602-7606
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Volume 14, Issue 3, July 2023

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Original article
ESTIMATION OF LIPOPROTEINS LEVELS & RISK OF CARDIOVASCULAR DISEASE
IN PSORIASIS.
Susmita Banerjee, Shilpa Joshi
Assistant Professor, Diamond Harbour Govt.Medical College & Hospital, Diamond Harbour,India
Assistant Professor, Dr.D.Y.Patil Medical College, D.Y.Patil Vidyapeeth, Pimpri, Pune, India

ARTICLE INFO ABSTRACT

Keywords:
Psoriasis is a chronic inflammatory & most common dermatologic diseases. It is related to
Psoriasis
several diseases but most common is cardiovascular disease. Lipid abnormalities are observed
dyslipidaemia
Cardiovascular risk in psoriasis patients at the earliest stages of the disease and so it may be genetically
low density lipoprotein determined.Hence there is a great need to study lipid abnormalities in psoriatic patients, which
high density lipoprotein will help us to evaluate the level of risk individuals may experience for developing
HDL/LDL ratio atherosclerosis and vascular obstructive disorders, as well as associated morbidity and
mortality. Aim: To estimate lipoproteins levels & related risk of cardiovascular diseases in
psoriasis patients. Materials and Methods: This is a community-based cross sectional analytical
study. The study population was derived from the healthy ambulatory person in and around
Pimpri area & was conducted in Dr. D.Y.Patil Medical College & Hospital, Pimpri Pune. Study
group consist of 40 psoriatic patients with mean age of 50.68 ± 8.86 years and control group
consisted of 40 healthy individual of either sex with mean age of 50.15 ± 9.6 years. 55 % males &
45 % females were present in control group while test group comprises of 59 % males & 41 %
females. estimation of Serum total cholesterol, Serum triglyceride, Serum High-Density
Lipoprotein-cholesterol & Serum Low density Lipoprotein levels were done the same day.
Estimation of lipoproteins levels done by Enzymatic End Point Method. Tha data was analysed
by calculating mean, standard deviation, p-value and Chi-square test. Results : Findings of this
show that, total cholesterol ,VLDL was significantly increased in psoriasis compared to
control(p<0.05).Difference between psoriasis cases(6.8 ± 1.49) and control (3.08 ± 1.3) in
findings of serum TGs were highly significant(p<0.001).However, difference in between serum
LDL level in psoriasis cases and control was not significant. There were no significant changes
shown in serum HDL level in both psoriasis cases and control . LDL/HDL ration has not shown
any significant changes in both psoriasis case and control, while in TC/HDL ratio, difference was
statistically significant(p<0.05). Conclusion: Present study suggests that patients with
psoriasis were associated with hyperlipidaemia. So have high risk of developing the
cardiovascular diseases. We suggest that screening of serum lipid profile in psoriatic patients
will help in evaluating risk at early stage. Impromptu treatment in these patients will prevent
the risk of cardiovascular diseases.
c
Copyright 2023 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved.

Introduction
Psoriasis is a chronic inflammatory & most common
dermatologic diseases [1]. It affects only 1% of world
population[2]. It is related to several diseases but most common is
cardiovascular disease. Atherosclerosis plays the most important
role in cardiovascular disorders. Atherosclerosis is caused by
inflammation and disturbed balance of the lipid metabolism [2].
Lipid abnormalities are detectable in psoriasis patients at the
* Corresponding Author : Dr. Shilpa Joshi
Bharati Vidyapeeth Medical College,Pune,India
E-mail: shilpajoshipune@gmail.com
c Copyright 2023 BioMedSciDirect Publications IJBMR - All rights reserved.
earliest stages of the disease and may therefore be genetically
determined [3]. Studies have shown that patients with psoriasis
may have an increased risk of variety of non-cutaneous diseases,
including arterial and venous occlusive diseases. Changes in the
plasma lipid and lipoprotein composition in patients with
psoriasis may be the reason for the increased risk of
atherosclerosis in these individuals [4-5].
The abnormalities of fatty acid composition in epidermal cells,
adipose tissue and erythrocytes in psoriasis patients have been
observed suggesting that perturbation of lipid metabolism may be
generalized phenomenon in psoriasis[6].
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7603

In psoriasis patients, an increased risk of cardiovascular 4 < 200 mg/dl : Normal

abnormalities, hypertension, dyslipidaemia, atherosclerosis,
4 200-239mg/dl :Borderline
diabetes type 2 ,obesity, chronic pulmonary obstructive disease,
osteoporosis have been found[7]. Hence there is a great need to 4 >240mg/dl : high
study lipid abnormalities in psoriatic patients, which will help us to
ESTIMATION OF SERUM TRIGLYCERIDES
evaluate the level of risk individuals may experience for developing
atherosclerosis and vascular obstructive disorders, as well as METODOLOGY:-Enzymatic method-Glycerol phosphate/
associated morbidity and mortality[8]. peroxidase
OBJECTIVES:- REFERENCE RANGE:-
1. Estimation of serum total cholesterol, HDL-cholesterol, LDL- 4 Upto 150 mg/dl : Normal
cholesterol and triglyceride levels in psoriasis patients and healthy
4 150—199mg/dl: Borderline-high
asymptomatic control group.
4 200-499mg/dl :High
2. Estimation of VLDL,TC/HDL ratio, LDL/HDL ratio.
4 >500mg/dl : very high
3. Comparison of the above parameters of psoriatic patients with
controls. .ESTIMATION OF SERUM HIGH DENSITY LIPOPROTEIN
METHODOLOGY: Enzymatic End Point Method
Materials and Methods:
REFERENCE RANGE:-Normal serum level
The study was conducted at Dr. D. Y. Patil Medical College,
Hospital and Research Centre, Pimpri, Pune. It was a community- Upto 35mg/dl High risk
based cross sectional analytical study. The study was conducted >60mg/dl Low risk
during April 2012 to May 2013. The study population was derived
from the healthy ambulatory person in and around Pimpri area. The ESTIMATION OF SERUM LOW DENSITY LIPOPROTEIN
study was started after the approval of the Institutional Ethics METHODOLOGY: Enzymatic End Point Method
Committee (IEC) vide letter dated DYPMC/06/DPU/14/03/2013(&
written consent in local language from all the participants. The study REFERENCE RANGE:- 80-150mg/dl
did not entail any additional cost to the patient and no financial TC/HDL and LDL/HDL ratio were determined.
compensation was being offered to any of the participants.
STATISTICAL ANALYSIS:-
STUDY POPULATION:- Subjects were selected as per the inclusion &
exclusion criteria Analysis of the data was done using the statistical methods such
as determination of mean,standard deviation,p-value and Chi-
Test group I:-This study group consist of 40 psoriatic patients of square test.
either sex.
· Inclusion criteria:- Patients of psoriasis of age between 30 yrs RESULT AND OBSERVATIONS:
to 70 yrs. Table No.1 Distribution of age in controls and cases:-
Control group II:-The control group consisted of 40 healthy
individual of either sex
· Inclusion Criteria:- . Healthy volunteers of age between 30 yrs
to 70yrs.
· Exclusion Criteria: - was same for both the groups (Test and
Control). The Subjects were excluded who were not willing to give
written consent, Patients with any documented acute or chronic
systemic illness, Subjects on supplements or any medications as well
as Smokers and alcohol users.
Fasting blood samples were collected from all the participants
into 5ml plain bulb or plain vacutainer without anticoagulant. The
samples were allowed to clot and were separated within 30-45
minutes of collection. Supernatant used after centrifugation for
estimation of Serum total cholesterol, Serum triglyceride, Serum
High-Density Lipoprotein-cholesterol & Serum Low density
Lipoprotein levels on the same day.
Table no.1 depicts the distribution of age of cases and controls. It was
ESTIMATION OF SERUM TOTAL CHOLESTEROL observed that mean age of control and psoriatic cases were not
Methodology:- Enzymatic method-Cholesterol oxidase/peroxidase showing statistically significant difference (p = 0.76).
REFERENCE RANGE:-
 Susmita Banerjee and Shilpa Joshi /Int J Biol Med Res.14(3):7602-7606
7604

Table no.2: Sex distribution of Cases and Controls :- Serum triglycerides levels were significantly decreased in
psoriasis cases as compared to control at 150mg/dl i.e. desirable
category. Triglyceride level >200mg/dl, was found in psoriasis cases
as compared to control (P < 0.001) which was statistically highly
significant.
The mean serum triglyceride levels are higher in psoriatic cases
as compared to the control. The difference was statistically
significant (p<0.001) shown in table 4.
Table no.2 depicts sex distributions between cases and controls.
Table no.5:Distribution of cases and controls according to
The gender distribution between psoriatic cases and control was not
serum high density lipoprotein (HDL) levels
statistically significant (p=0.371). In this study, of the total psoriasis
patients, 59% were males and 41% were females, it was observed
that females had lower mean percentage of psoriasis as compared to
males.

Table no.3: Distribution of cases and controls according to

serum total cholesterol

The serum HDL levels were lowered in cases as compared to control

group. The difference was statistically not significant (p=0.22).
Table no.6: Distribution of cases and controls according to
serum low density lipoprotein (LDL) levels

* P< 0.05 as compared to control.

It was observed that 70% of control and 55% of psoriatic cases
shown serum total cholesterol upto 200mg/dl. However, 30 % of
both control and psoriatic cases shown borderline serum total
cholesterol (200-239mg/dl), & no statistically significant difference
was found between these groups. Total cholesterol level were
significantly increased in psoriatic cases as compared to control at
high serum cholesterol(>240mg/dl).
Statistically significant increase was found in psoriasis cases as
compared to control. (P < 0.001) in serum LDL levels at >150mg/dl.
Table no.4: Distribution of cases and controls according to The mean serum LDL levels are higher in psoriatic cases but
serum triglyceride levels(TG) statistically not significant (p=0.062).
Table no.7: Distribution of cases and controls according to
LDL/HDL ratio

The LDL/HDL ratio in both control and psoriatic cases at both <3.5
and >3.5 level were noted, difference is not statistically significant.
The difference in mean LDL/HDL ratio between cases and control is
not significant statistically p value=0.223.
 Susmita Banerjee and Shilpa Joshi /Int J Biol Med Res.14(3):7602-7606
Table no.8: Distribution of cases and controls according to
TC/HDL ratio
The distribution of TC/HDL in > 4.99 category in psoriatic cases was
more than control, the difference was statistically significant.
TC/HDL ratio is higher among psoriatic patients as compared to the
controls. The difference was statistically significant with p
value=0.043
Table no.9:Distribution of cases and controls according to very
low density lipoprotein levels(VLDL)
In distribution of psoriasis cases and control at < 40mg/dl category,
serum VLDL levels were significantly decreased in psoriasis cases as
compared to control.
Increase in VLDL level i.e. > 40 mg/dl, which was highly significant in
psoriasis cases as compared to control. (P < 0.001)
Rise in VLDL levels in psoriatic patients, as compared to control is
statistically significant with p value=0.005.
Table no. 10: Distribution of lipid parameters, in control and
cases in terms of Mean ± S.D
7605
Discussion
Evidences indicates psoriasis is an independent risk factor for
cardiovascular disease. Dyslipidemia, obesity diabetes,
hypertension ,coronary calcification, increased C-reactive protein
(CRP), decreased folate and hyperhomocystenimia are found with
significantly higher frequency in psoriasis patients. Inflammation is
the common theme underlying both conditions.
In our study, psoriasis is predominant in males as compared to
females, similar findings were observed in study done by Sunil
Dongra et al (2010). They observed females had lower mean
percentage of psoriasis as compared to males[9]. The serum total
cholesterol is significantly higher in psoriatic patients in present
study, there were several studies have demonstrated that serum
total cholesterol levels are higher in psoriasis[10-11] , these findings
supports our present study.
Similar results were seen with the serum triglyceride levels,
higher in psoriatic patient, however in most studies serum
triglyceride levels have shown a significant elevation[12-13].
In present study, low density lipoprotein (LDL), were not
significantly increased in psoriatic patient compared to control
while in other study, low density lipid have increased in psoriasis
patient[14-17]. This shows contradictions to our present study.
The most important role of HDL particle is reverse cholesterol
transport. Modified HDL particles in atherosclerotic plaques
stimulates cholesterol efflux from foam cells, endothelial dependent
vasoreactivity and anti-oxidative activity. Seishima observed normal
values for total cholesterol and HDL values in 38 psoriatic
patients[18]. In this study HDL values are decreased as comparative
to control group.
An increased number of VLDL are strongly associated with
coronary heart disease. Hypertriglyceridemia secondary to VLDL
elevation is associated with both pro-coagulant and pro-thrombotic
factors in the blood and affects the adhesiveness of platelets. Resting
platelets circulate freely. Neither adhering to each other nor to other
cells. However, activated platelets adhere to all lipoproteins,
especially VLDL. VLDL-mediated platelet adhesion may play an
important role in the progression of atherosclerosis. Furthermore,
VLDL remnants are susceptible to retention within the arterial
intima, thereby promoting atherosclerotic plaque growth3. In this
study LDL/HDL value in psoriatic patients & control are not
significantly different. But TC/HDL ratio & VLDL levels in psoriatic
patients are increased statistically as compared to control[19]. This
study shows an association between psoriasis and lipid
abnormalities with indication of high risk of cardiovascular diseases
in patients with psoriasis.
Limitations:
Present study had a few limitations. Different types of
morphological psoriasis were not included and follow-up after
treatment was not undertaken. Secondly, relatively smaller sample
sizes, involving only 80 study subjects, were used in the study. A
larger sample size would have validated our results further research.
Conclusion:
Present study suggest that patients with psoriasis are associated
with hyperlipidaemia. So have high risk of developing the
cardiovascular diseases. We suggest that screening of serum lipid
profile in psoriatic patients will help in evaluating risk at early stage.
Impromptu treatment in these patients will prevent the risk of
 Susmita Banerjee and Shilpa Joshi /Int J Biol Med Res.14(3):7602-7606
7606

cardiovascular diseases. Furthermore, these simple indices may be
helpful for cardiovascular risk assessment in psoriasis, thus obviate
the need for expensive biomarkers which can be restricted to
research settings.
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