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CBC values linked to CVD risk in psoriasis.

ORLANDO -- Elevated red blood cell distribution width and mean platelet volume were correlated with cardiovascular disease in a review of 39,510 psoriasis patients conducted by researchers at Case Western Reserve University, Cleveland.

It's generally accepted that psoriasis increases the risk of cardiovascular disease (CVD), but it's not clear who's most at risk. "We really wanted to find something that is cheap and easy to risk stratify these patients" said lead investigator Rosalynn Conic, MD, of Case Western's department of dermatology.

Red blood cell distribution width (RDW)--a measure of the range of red blood cell volumes in a given sample--and mean platelet volume (MPV) fit the bill. In many places, they are already routinely reported on CBCs, so there's no need for any special equipment or tests. Meanwhile, RDW and MPV elevations have been previously linked to CVD risk in the HIV and cardiology liter ature. The investigators wondered if they'd find a similar association in psoriasis, so they queried nearly 40,000 patients in the Explorys electronic health record database.

What they found was "very impressive," Dr. Conic said at the International Investigative Dermatology meeting.

The incidence of MI was highest among the 1,920 patients (5%) with elevated RDW and MPV (odds ratio, 3.4; 95% confidence interval, 2.7-4.2; P less than .001), followed by the 7,060 (18%) patients with high RDW and normal MPV (OR, 2.4; 95% CI, 2.1-2.8; Pless than .001), as compared with normal/low MPV and RDW patients.

Elevated RDW or elevated RDW plus MPV increased the odds of atrial fibrillation, coronary artery disease, heart failure, and peripheral vascular disease anywhere from 2 to 8.3 times (P less than .001). Among psoriatic arthritis patients, elevated RDW almost doubled the risk of MI (OR, 1.8; P less than .001). Results were adjusted for age, gender, and hypertension.

In a subanalysis of treatment effects, 4 of 23 psoriasis patients at Case Western had elevated RDWs at baseline. Values normalized in the three patients who achieved a 75% reduction in the Psoriasis Area and Severity Index score after about a year of systemic treatment.

"We aim to validate [the study results] with a Veterans Administration data set," Dr. Conic said. If it pans out, "one use would be to send [patients with elevated values] to a car diologist earlier" so other CVD risk factors can be monitored and treated. The findings also add to the case for good control, she noted.

Systemic inflammation is the common denominator between the blood value elevations and CVD. The same inflammatory cytokines that cause skin problems in psoriasis also stimulate bone marrow to release immature red blood cells, which are larger than mature cells, leading to an increased RDW. Similarly, elevated MPV indicates a higher number of larger, younger platelets in the blood.

"It's probably something along those lines, but I think we need to go back to basic science and really figure it out," Dr. Conic said.

Patients were 18-65 years old. The study excluded patients with diabetes, Crohn's disease, RA, and generalized atherosclerosis.

The National Institutes of Health funded the work. Dr. Conic reported no relevant financial disclosures.

SOURCE: Conic R et al. IID 2018, Abstract 550.



Caption: Dr. Rosalynn Conic

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Author:Otto, M. Alexander
Publication:Dermatology News
Date:Jul 1, 2018
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