Vol 24, No 3 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-21

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Chemerin as a marker of subclinical cardiac involvement in psoriatic patients

Feyza Aksu1, Mustafa Caliskan, Nursen Keles, Aybala Erek Toprak, Tugba Kevser Uzuncakmak, Osman Kostek, Yusuf Yilmaz, Kenan Demircioglu, Esad Cekin, Ibrahim Ozturk, Ayse Serap Karadag
Pubmed: 28353314
Cardiol J 2017;24(3):276-283.


Background: Chemerin has been associated with psoriasis and inflammation, but there are no studies demonstrating an association between chemerin and subclinical cardiac involvement in psoriatic patients. Therefore, the present study aimed to evaluate whether psoriatic patients with increased epicardial fat tissue, impaired flow-mediated dilatation, and diastolic dysfunction have higher serum chemerin levels than a healthy control group.

Methods: The study included 60 psoriatic patients and 32 healthy controls. Echocardiographic parameters, epicardial fat tissue, flow-mediated dilatation, and chemerin levels were recorded for both groups.

Results: The serum levels of chemerin in the psoriatic patients were significantly higher than in the control group. The diastolic function parameters, including isovolumic contraction and relaxation time, E’/A’ (early diastolic mitral annular velocity/late diastolic mitral annular velocity), and E/E’ (early diastolic peak velocity of mitral inflow/early diastolic mitral annular velocity) values, differed significantly between the groups. Epicardial fat tissue was significantly higher and flow-mediated dilatation was significantly lower in psoriatic patients than in the controls. Chemerin was significantly positively correlated with age, body mass index, systolic and diastolic blood pressures, waist circumference, E/E’, and epicardial fat tissue. Serum chemerin was significantly negatively correlated with E’, E’/A’, and flow-mediated dilatation. A multiple linear regression analysis showed that chemerin was independently correlated with E/E’.

Conclusions: Psoriatic patients exhibit early subclinical atherosclerosis and diastolic dysfunction. Chemerin can be used as a marker to screen for patients with subclinical cardiac involvement.

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  1. Zabel BA, Allen SJ, Kulig P, et al. Chemerin activation by serine proteases of the coagulation, fibrinolytic, and inflammatory cascades. J Biol Chem. 2005; 280(41): 34661–34666.
  2. Bozaoglu K, Bolton K, McMillan J, et al. Chemerin is a novel adipokine associated with obesity and metabolic syndrome. Endocrinology. 2007; 148(10): 4687–4694.
  3. Albanesi C, Scarponi C, Pallotta S, et al. Chemerin expression marks early psoriatic skin lesions and correlates with plasmacytoid dendritic cell recruitment. J Exp Med. 2009; 206(1): 249–258.
  4. Gelfand JM, Weinstein R, Porter SB, et al. Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol. 2005; 141(12): 1537–1541.
  5. Bülbül Şen B, Ekiz Ö, Rifaioğlu EN, et al. Assessment of subclinical left ventricular dysfunction in patients with psoriasis by speckle tracking echocardiography: A Speckle Tracking Study. Int J Dermatol. 2016; 55(2): 158–164.
  6. Gullu H, Caliskan M, Dursun R, et al. Impaired coronary microvascular function and its association with disease duration and inflammation in patients with psoriasis. Echocardiography. 2013; 30(8): 912–918.
  7. Mancini GB. The fire within psoriatic patients: overlap between inflammatory and cardiovascular diseases. Can J Cardiol. 2015; 31(3): 242–243.
  8. Shang Q, Tam LS, Yip GWK, et al. High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol. 2011; 38(7): 1363–1370.
  9. Barutcu A, Aksu F, Ozcelik F, et al. Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus with or without anticardiolipin antibodies. Lupus. 2015; 24(10): 1019–1028.
  10. Yu CM, Sanderson JE, Marwick TH, et al. Tissue Doppler imaging a new prognosticator for cardiovascular diseases. J Am Coll Cardiol. 2007; 49(19): 1903–1914.
  11. Deanfield J, Donald A, Ferri C, et al. 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(1): 7–17.
  12. Iacobellis G, Barbaro G. The double role of epicardial adipose tissue as pro- and anti-inflammatory organ. Horm Metab Res. 2008; 40(7): 442–445.
  13. Gorter PM, de Vos AM, van der Graaf Y, et al. Relation of epicardial and pericoronary fat to coronary atherosclerosis and coronary artery calcium in patients undergoing coronary angiography. Am J Cardiol. 2008; 102(4): 380–385.
  14. Ding J, Hsu FC, Harris TB, et al. The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2009; 90(3): 499–504.
  15. Fang Na, Jiang M, Fan Yu. Association between psoriasis and subclinical atherosclerosis: A meta-analysis. Medicine (Baltimore). 2016; 95(20): e3576.
  16. Balci A, Celik M, Balci DD, et al. Patients with psoriasis have an increased amount of epicardial fat tissue. Clin Exp Dermatol. 2014; 39(2): 123–128.
  17. Potenza C, Raimondi G, Pampena R, et al. Cardiovascular risk evaluation through heart rate variability analysis in psoriatic patients before and after 24 weeks of etanercept therapy: Prospective study. J Int Med Res. 2016; 44(1 suppl): 43–47.
  18. Ramsay B, Lawrence CM. Measurement of involved surface area in patients with psoriasis. Br J Dermatol. 1991; 124(6): 565–570.
  19. Keles N, Dogan B, Kalcik M, et al. Is serum Klotho protective against atherosclerosis in patients with type 1 diabetes mellitus? J Diabetes Complications. 2016; 30(1): 126–132.
  20. Keles N, Caliskan M, Dogan B, et al. Low serum level of Klotho is an early predictor of atherosclerosis. Tohoku J Exp Med. 2015; 237(1): 17–23.
  21. Horreau C, Pouplard C, Brenaut E, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol. 2013; 27 Suppl 3: 12–29.
  22. Proietti I, Raimondi G, Skroza N, et al. Cardiovascular risk in psoriatic patients detected by heart rate variability (HRV) analysis. Drug Dev Res. 2014; 75 Suppl 1: S81–S84.
  23. Han J, Kim SoH, Suh YJu, et al. Serum chemerin levels are associated with abdominal visceral fat in type 2 diabetes. J Korean Med Sci. 2016; 31(6): 924–931.
  24. Lehrke M, Becker A, Greif M, et al. Chemerin is associated with markers of inflammation and components of the metabolic syndrome but does not predict coronary atherosclerosis. Eur J Endocrinol. 2009; 161(2): 339–344.
  25. Biyik I, Narin A, Bozok MA, et al. Echocardiographic and clinical abnormalities in patients with psoriasis. J Int Med Res. 2006; 34(6): 632–639.
  26. Choong CY, Abascal VM, Thomas JD, et al. Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. Circulation. 1988; 78(3): 672–683.
  27. Nagueh SF, Middleton KJ, Kopelen HA, et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997; 30(6): 1527–1533.
  28. Garcia MJ, Ares MA, Asher C, et al. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol. 1997; 29(2): 448–454.
  29. Weigert J, Neumeier M, Wanninger J, et al. Systemic chemerin is related to inflammation rather than obesity in type 2 diabetes. Clin Endocrinol (Oxf). 2010; 72(3): 342–348.
  30. Venugopal SK, Devaraj S, Yuhanna I, et al. Demonstration that C-reactive protein decreases eNOS expression and bioactivity in human aortic endothelial cells. Circulation. 2002; 106(12): 1439–1441.
  31. Wang CH, Li SH, Weisel RD, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation. 2003; 107(13): 1783–1790.
  32. Osto E, Piaserico S, Maddalozzo A, et al. Impaired coronary flow reserve in young patients affected by severe psoriasis. Atherosclerosis. 2012; 221(1): 113–117.
  33. Coimbra S, Oliveira H, Reis F, et al. C-reactive protein and leucocyte activation in psoriasis vulgaris according to severity and therapy. J Eur Acad Dermatol Venereol. 2010; 24(7): 789–796.
  34. Balci DD, Balci A, Karazincir S, et al. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. J Eur Acad Dermatol Venereol. 2009; 23(1): 1–6.
  35. Gonzalez-Juanatey C, Llorca J, Llorca J, et al. Endothelial dysfunction in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007; 57(2): 287–293.
  36. Wang CP, Hsu HL, Hung WC, et al. Increased epicardial adipose tissue (EAT) volume in type 2 diabetes mellitus and association with metabolic syndrome and severity of coronary atherosclerosis. Clin Endocrinol (Oxf). 2009; 70(6): 876–882.
  37. Bulbul Sen B, Atci N, Rifaioglu EN, et al. Increased epicardial fat tissue is a marker of subclinical atherosclerosis in patients with psoriasis. Br J Dermatol. 2013; 169(5): 1081–1086.