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Psoriasis Linked To Increased Risk Of Cardiovascular Disease By Mechanistic Discovery

AppId is over the quota AppId is over the quota Main Category: Eczema / Psoriasis
Also Included In: Cardiovascular / Cardiology
Article Date: 14 May 2012 – 0:00 PST Current ratings for:
Psoriasis Linked To Increased Risk Of Cardiovascular Disease By Mechanistic Discovery
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The link between psoriasis and cardiovascular events has been observed for years, however the mechanics were unknown. For the first time, Case Western Reserve University School of Medicine researchers have discovered preclinical evidence demonstrating that the inflammatory skin disease leads to cardiovascular disease. Further, the research demonstrated that aggressive reversal of psoriasis reduces the cardiovascular risk as well. Psoriasis is a chronic disease of the immune system that appears as raised, inflamed, scaly red patches of skin and is often associated with intense itch. In the United States, it affects between two and a half to six million patients. http://www.eczemablog.net/

Published in the Journal of Investigative Dermatology, the study used a new, innovative mouse model to demonstrate a causal connection between the skin disease and cardiovascular disease. Dr. Ward and her research team demonstrated that mice engineered to overexpress a protein called Tie-2 in the skin, develop a skin condition similar to human psoriasis. Using this model, they showed that persistent, chronic inflammation confined to the skin can result in inflammation in large arteries, such as the aorta.


“This discovery is paradigm shifting. There has been a link between the two diseases but to date we had not been able to show cause. Epidemiologic evidence from thousands of patients was convincing that psoriasis patients had a much greater chance of developing cardiovascular disease and dying from it,” says Nicole Ward, PhD, senior author of the study, assistant professor of dermatology and neurosciences at Case Western Reserve School of Medicine, and scientist with the Murdough Family Center for Psoriasis at University Hospitals Case Medical Center.


There is a known increased risk of heart, cerebrovascular, and peripheral artery diseases, as well as risk of death, in individuals suffering from a variety of chronic inflammatory diseases, such as rheumatoid arthritis (RA), colitis, gum disease, lupus, and psoriasis. Many researchers showed, statistically, that having psoriasis leads to an increased risk for cardiovascular disease and heart complications, however it was unclear why this occurs and it was challenging to separate out the significance of other lifestyle factors and their contributions to this risk, she adds.


Based on published clinical reports demonstrating psoriasis patients had increased risk of developing and dying of heart attack and stroke, Dr. Ward and her team set-out to investigate whether their mouse model of psoriasis would also show cardiac complications, mimicking these seen in human disease. They teamed up with experts in the role of inflammation in vessel injury – Yunmei Wang, PhD, assistant professor of medicine at the School of Medicine and Daniel I. Simon, MD the Herman K. Hellerstein Professor of Cardiovascular Research at the School of Medicine, and chief, Cardiovascular Medicine at University Hospitals Case Medical Center.


“We believed that chronic inflammation over a large area of the body may be the reason for an increased risk of cardiovascular complications in skin disease patients; however, until now we had no way to model and definitively prove this,” says Dr. Wang.


Dr. Ward and her team measured blood clot formation in the psoriasis mouse model and normal mice, revealing that time was greatly shortened in the diseased mice. This shortened time to vessel blockage is akin to a greater risk for blood vessel blockage in humans that leads to stroke or heart attack. Further examination revealed that mice with the skin disease also exhibited inflammation of the vessel wall similar to that observed with atherosclerotic lesions or plaques.


Importantly, and highly meaningful for patients with psoriasis, Dr. Ward’s work was able to demonstrate that upon reversal of the skin disease, the cardiovascular inflammation and blood clot formation were also decreased.


“Our observations of improved vessel wall inflammation and decreased clot formation following skin-specific repression of disease provide further evidence that skin inflammation promotes vascular inflammation and thrombosis and strongly suggests that aggressive treatment of skin disease may block pathways that produce cardiovascular disease in psoriasis patients,” says Dr. Ward.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our eczema / psoriasis section for the latest news on this subject. Dr. Ward presented these findings at the 2012 Society for Investigative Dermatology Annual Meeting in Raleigh, NC.
This research was funded by the National Institutes of Health, National Psoriasis Foundation, and the Murdough Family Center for Psoriasis.
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Link Between Severe Psoriasis And Increased Risk For Diabetes

AppId is over the quota AppId is over the quota Main Category: Eczema / Psoriasis
Also Included In: Diabetes
Article Date: 17 Oct 2012 – 0:00 PST Current ratings for:
Link Between Severe Psoriasis And Increased Risk For Diabetes
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An analysis of 27 studies linking psoriasis in 314,000 individuals with diabetes has found strong correlation between the scaly skin rash and the blood sugar disorder that predisposes patients to heart disease, say UC Davis researchers who led the review.

The findings appear in an article titled “Psoriasis and the risk of diabetes: a systematic review and meta-analysis,” which is now online in the Archives of Dermatology.


“Our investigation found a clear association between psoriasis and diabetes,” said April Armstrong, assistant professor of dermatology at UChttp://www.eczemablog.net/ Davis and principal investigator of the study. “Patients with psoriasis and their physicians need to be aware of the increased risk of developing diabetes so that patients can be screened regularly and benefit from early treatment.”


Psoriasis is a common skin problem that tends to run in families. It causes a raised red, flaky and sometimes itchy rash, often on the elbows and knees, although it can appear anywhere. It is believed to be an autoimmune disease, in which the body regards its own skin as foreign and mounts an inflammatory response.


Armstrong and her colleagues combined data from 27 observational studies of patients with psoriasis, in what is known as a meta-analysis. Five of the studies assessed the incidence of diabetes – that is, how many patients with psoriasis developed diabetes during the course of a study, which ranged from 10 to 22 years. The other studies assessed the prevalence of diabetes – how many patients already had diabetes at the outset of a study. Altogether, the studies evaluated more than 314,000 people with psoriasis and compared them to 3.7 million individuals (controls) without the disease.


Some of the studies classified patients by disease severity. The aggregate data for these studies showed that patients with mild psoriasis are over 1.5 times more likely to have diabetes than the general population while those with severe disease are nearly twice as likely. Among studies that assessed incidence, patients with psoriasis had a 27 percent increased risk of developing diabetes compared with the general population.


All but one study analyzing incidence found a link between psoriasis and diabetes. These studies included patient data from outpatient clinics, insurance claims and hospitals. Diabetes rates were similar in patients despite ethnicity or country where the study was conducted.


“The large sample size and consistent association between psoriasis and diabetes make these study findings very strong and suggest an underlying physiological link between the two diseases,” said Armstrong, who directs the Dermatology Clinical Research Unit at UC Davis and the teledermatology program.


While additional research is need to understand how the two diseases are associated, Armstrong believes altered immune pathways may make psoriasis patients more susceptible to developing diabetes.


“There is evidence that fat cells in psoriasis patients may not function normally,” she said. “These cells secrete inflammatory substances known as cytokines that increase insulin resistance in the liver and muscle and initiate destruction of insulin-producing cells in the pancreas.”


Additional research will also clarify other potential limiting factors in the current study. For example, the study’s authors noted that epidemiological or observational studies can be susceptible to confounding factors, such as concurrent medications used to treat psoriasis that may modulate the risk of developing diabetes.


Armstrong’s study adds to a growing body of research that shows psoriasis is not just skin deep. “We know patients with psoriasis and hypertension tend to require more aggressive therapy to bring their blood pressure under control,” said Armstrong. “We also know that psoriasis patients have higher rates of heart attacks, strokes and cardiovascular-related deaths than the general population. Primary-care physicians need to be aware of these underlying predispositions to disease to provide the best care to their patients.”


Armstrong and her colleagues plan to examine endothelial cells – cells that line blood vessels – to better understand the underlying physiological basis of psoriasis. They also are collaborating with other research institutions to develop a network to share clinical data on patients with psoriasis.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our eczema / psoriasis section for the latest news on this subject. The study’s other authors were Caitlin Harskamp, also of the UC Davis Department of Dermatology, and Ehrin Armstong, an interventional cardiologist with the UC Davis Division of Cardiovascular Medicine. Armstrong and her colleagues also received training and support for their systematic review and meta-analysis from the UC Davis Center for Healthcare Policy and Research.
University of California – Davis Health System Please use one of the following formats to cite this article in your essay, paper or report:

MLA

University of California – Davis Health System. “Link Between Severe Psoriasis And Increased Risk For Diabetes.” Medical News Today. MediLexicon, Intl., 17 Oct. 2012. Web.
7 Apr. 2013. APA

Please note: If no author information is provided, the source is cited instead.


‘Link Between Severe Psoriasis And Increased Risk For Diabetes’

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.


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All opinions are moderated before being included (to stop spam)


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For any corrections of factual information, or to contact the editors please use our feedback form.

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Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.



View the original article here


Eczema Blog

How the growing elderly care sector is leading to increased responsibility for nurses

Along with a national nursing shortage, growing debts and the ongoing dispute about junior doctors’ contracts, the UK’s ageing population is often cited as a major threat to our National Health Service. Today, over 3 million people in the UK are aged 80 or over. Incredibly, by 2050 that number is expected to have almost doubled to 8 million. And, as the population lives for longer than ever, we will require ever greater levels of healthcare, much of which will be accessed via primary care facilities, and provided by community nurses. While serious, life-threatening illness will be staved off by many into the eighth and ninth decades (and beyond), it will be ongoing, low-level health concerns of aged people that will put unprecedented strain on the NHS’s frontline services.

young nurse measuring the patient's blood pressure

Over the last two or three decades, there has been a discernible shift in the roles of GPs and nurses working within primary care. Increasingly, nurses have taken on greater responsibility, undertaking both medical, prescribing and managerial tasks that would previously have fallen to the doctors. However, many experienced nurses have argued that despite being asked to fulfil these much more complex duties, unlike GPs, nurses aren’t always provided with adequate training to complete them with confidence.

At its core, nursing care for elderly patients who are not facing terminal illness is concerned with helping them retain both their independence and a comfortable quality of life. While an elderly person will inevitably be forced to face increased frailty, good community nursing is an important weapon in the NHS’s attempts to make this as pain-free as possible. It seems likely that as ever more people survive beyond their 70s, community nurses will have to upskill, preparing themselves both to prevent disease and illness and to maintain and enhance individuals’ capacity to enjoy life physically, psychologically and socially.

For nurses, this must appear both as an exciting challenge and as a huge undertaking. While once the job of one nurse was much like that of the next, for this and future generations of nurses, the role will become more complex and demanding. A greater number of visits to patients’ homes, a better understanding of geriatric care and, potentially, the requirement to retrain in one or more specialist areas related to the health of elderly people, may arise for many nurses. Contemporary nurses, unlike those who went before them, wear uniforms that tell patients their level of seniority within their teams and they constantly develop their skills through expert training courses; every year nursing is becoming a more complex job.

Right now it’s impossible to say how positive the impact of community nursing will be in the push to improve elderly care. However, it certainly seems that nowadays, particularly when it comes to elderly patients, nursing is no longer ‘just a job’, it is an exceptionally important career.

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