1.

soriasis is a chronic inflammatory disease related to many diseases, especially cardiovascular disease. Among these diseases, atherosclerosis plays the most important role. 1 Atherosclerosis is caused by inflammation and an imbalance of the lipid metabolism. Psoriasis and atherosclerosis not only share the same cytokines involved in the immunological mechanism, such as interleukin-17 (IL-17), but also have common angiogenic factors and oxidative pathways. 2 In addition, both of them have similar lipid profiles, including decreased high-density lipoprotein (HDL) levels and/or increased low-density lipoprotein (LDL) levels. 3 In the pathological process of atherosclerosis, the accumulation of cholesterol triggers the production of pro-inflammatory cytokines, such as Tumor Necrosis Factor Alpha (TNF?), and also leads to the aggregation of monocytes and differentiation into foam cells. TNF? eventually induces an inflammatory cascade in blood vessels. 4 In chronic inflammation TNF? may also influence the lipid profile, such as LDL-C levels, via a decreased concentration of a Apolipoproteins. Moreover, TNF? lowers the quality of lipoprotein by inducing the production of LDL and Oxidized LDL (oxLDL) and reducing the level of HDL-C at the same time. Oxidized LDL (oxLDL) not only exacerbates the inflammation but also promotes cholesterol accumulation in lysosomes, which eventually leads to cell death. On the other hand, HDL has a reverse cholesterol transport (RCT) function, anti-oxidative capacity, and anti-inflammatory properties by regulating dendritic cells' (DCs) differentiation, and reducing T cell activation and IL-12 production. However, these properties are reduced during chronic inflammation, such as psoriasis. 5 In this study our main goal is to evaluate the incidence of lipoprotein disorder in psoriasis patients attending tertiary care hospital in Bangladesh.

2. II.

3. Objective

To assess the incidence of lipoprotein disorder in psoriasis patients attending tertiary care hospital in Bangladesh.

4. Medical Research

Volume XXI Issue VI Version I

The Incidence of Lipoprotein Disorder in Patients with Psoriasis Attending in a Tertiary Care Hospital of Bangladesh III.

5. Methodology a) Type of Study

This study is a case control study.

6. b) Place of study

7. g) Study Procedure

Patients attending in the Dermatology Department were diagnosed case or psoriasis was included in the study. 60 patients with age matched control who were attending in the same Department with skin problem were also selected. These patients were selected after excluding the exclusion criteria, Psoriasis was diagnosed clinically attending in the CMCH. Secondary causes of Diabetes Mellitus and Hypertension were also excluded clinically. Selected patients were informed about the aims, objectives, significance and detail procedure of the study before examination. An informed written consent was taken from all the patients who was selected for the study and encouraged for voluntary participation and allowed freedom to withdraw from the study whenever they liked even after participation. All eligible subjects will be provided a structured questionnaire with direct supervision by the researcher herself to obtain socio-demographic and health related Then clinical examination was done. V.

8. Discussion

Among the study subjects 60 (50% of the study Subjects) out of 120 patients were with Psoriasis and 60 (50% of the study subjects) out of 120 were without Psoriasis. The patients with Psoriasis were in the age group of 41-50 years. Among gender distribution 72(60% of the study subjects) were male. Group A and group B were statistically insignificant (p0.0).

In our study most of the Psoriasis patients were male (72%). The mean age of the Psoriatic patients are 44 years, which is supported by one other study. 6 In our country female are less conscious about their health.

They have to do many households work. Economically they depend on males. For health related problems, they go to local village doctors for treatment. So, their attendance in tertiary level hospital like CMCH may be less than male.

In one large population-based study from the UK in which over 130,000 patients with psoriasis were included, showed higher incidences of Diabetes and Hypertension. Another study used the General Practice Research Database and found higher rates of Diabetes Mellitus, Hypertension, Hyperlipidemia, obesity and smoking in patients with psoriasis than in the controls subjects. [7][8] In one case control study conducted in USA in 2008 with data taken from the study of 1127 patients with Psoriasis and matched cohort of non-Psoriatic patients, Psoriatic patients were significantly more likely to develop Cardiovascular Co-Morbidities including Diabetes Hypertension, Hypercholesterolemia, compared with non-psoriasis patients. 9 In a hospital based case control study conducted in Italy, Metabolic Syndrome like Hyperglycemia, Hyperlipidemia, Hypertension was found significantly more common in Psoriatic patients than in controls (30.1% vs 20.6%, Odds ratio 1.65). 10 Another case control study conducted in Korea investigators also found a higher prevalence of metabolic syndromes (17.8%), Cardiovascular disease (4.6%), Hypertension (32.5%) and Hyperlipidemia (22.3%) in patients with Psoriasis, as compared with that of the controls. 11 Regarding diastolic blood pressure mean±SD was found 82.67±7.04 mmHg in group A and it was 78.30±9.31 mmHg in group B. It was also found significant (p<0.05). Mean±SD of fasting biood sugar was found 102.53±27.67 mg/dl and post prandial blood sugar was found 144.75 ± 49.98 mg/dl among the group A patients whereas it was 92±15.37 mg/dl and 121±41.41 mg/dl in group B. Both the distribution is statistically significant (p<0.05). Among the study subjects DM was found in 26 patients (43.

Figure-1: Gender distribution of the study In figure-1 shows gender distribution of the study subjects where most of the patients were male in both groups. The following figure is given below in detail: — Figure 1. Figure- 1 :

Figure 2. Table - 1

The Incidence of Lipoprotein Disorder in Patients with Psoriasis Attending in a Tertiary Care Hospital of
			Bangladesh
			IV.	Results
		N	Mean	±SD	Median	Range	Significance
Age (years)	Group A	60	47.78	9.81	48.00	27-65	P=0.159 NS
	Group B	60	44.97	11.86	47.00	26-65
				Blood pressure was recorded by a standard
				Sphygmomanometer in sitting position aller 30
				minutes rest. At least two records of blood pressure
				of the patient were taken on two occasions. Then
				average blood pressure was noted. Patients were
				asked to come in fasting condition for at least 8 to
				12 hours. Fasting blood sample was taken for
				fasting blood sugar and fasting lipid profile. Then
				patients were given 75gm glucose mixed in 300ml
				of plain water. After two hours second blood sample
				was also collected for post prandial blood sugar.
				Blood sample was collected by same laboratory
				technologist and analysis was done in the Clinical
				Pathology Department of CMCH.
				h) Data Collection Method
				All relevant information for each individual study
				subject was recorded on pre-tested data sheet. The data sheet was used for collection of information.				D D D D ) K
				Data was collected by the researcher.				(
				i) Data Processing Plan
				Data was processed and analyzed using computer
				software SPSS (Statistical Packages for Social Sciences
				Version-19). The test statistics was used for analysis of
				data are student's t test (for comparison of data
				presented in quantitative scale like blood glucose level),
				Chi-square test (for comparison of data presented in
				categorical scale like presence of DM and HTN in two
				groups). For any analytical test the level of significance
				is 0.05 and P-value <0.05 was considered significant.
							© 2021 Global Journals

Figure 3. Table 1 :

Figure 4. Table 2 :

Study Groups	Frequency	Percentage
GroupA (With Psoriasis)	60	50%
Group B (without Psoriasis)	60	50%
Total	120	100%

Figure 5. Table 2 :

		Table-3: Socio Demographic status of patients.
			Study group
	Variables	Group A, %		Group B, %		X 2 Test of significance
		Number	% percent	Number	% percent
Sex	Male Female	40 20	66.7 33.3	72 48	53.3 46.7	P= 0.136 NS
Age group	?30 years 31-40 years	6 8	10.0 13.3	20 21	23.3 21.7	P=0.121 NS
	41-50 years	24	40.0	38	23.3
	51-60 years	18	30.0	33	25.0
	>60 years	4	6.7	8	6.7

Note: In table-3 shows socio demographic status of patients. Among the study subject, two third was male. There was no significant difference in sex between group A and group B. In group A most of the patients belong to 4th decade and in group B was equal distribution of age group between 30-60 years. The following table is given below in detail In table-6 shows distribution of study groups according to blood pressure. There was a significant difference in systolic blood pressure and diastolic blood pressure between group A and group B.

Figure 6. Table - 7

	Table-8: Distribution of study groups according to lipid profile
Lipid profiles		N	Mean	±SD	Medium	Range	Sign.
Serum total	Group A	60	182.58	40.64	188.50	101-299	P=0.034
cholesterol (mg/dl)	Group B	60	168.52	30.27	170.00	80-200	significant
Serum HDL (mg/dl)	Group A	60	37.97	6.68	37.50	20-62	P=0.032 significant
	Group B	60	35.73	4.38	36.00	30-42
Serum LDL		N	Mean	±SD	Medium	Range	Sign.
(mg/dl)	Group A	60	120.47	29.63	125.00	65-185	P=0.022
	Group B	60	109.52	21.15	110.00	68-144	significant
		N	Mean	±SD	Medium	Range	Sign.
Serum TG	Group A	60	160.70	40.28	160.00	80-240	P=0.046
(mg/dl)	Group B	60	146.43	37.14	140.50	75-210	significant

Note: Table-8 shows distribution of study groups according to lipid profile. There was significant difference in serum Total Cholesterol, HDL, LDL and TG between group A and B.

Figure 7. Conclusion 1 .

VI.
of Dyslipidemia?
3. Exploration	of	the	relationship	between
Hyperlipidemia and Psoriasis may unveil the
discovery of another novel treatment option for
psoriasis with most promising outcome.
3) in group A
and 10 patients (16.7%) in group B.[{OR(CI)}= 3.824
(1.635-R 8.942)]. p:0.051. HIN found 23(38.3%) in group
A and 8(13.3%) in group B [{OR(CI)}= 4.041 (1.629-
10020)]. p<0.05).

Appendix A

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Davidsons's Principles and Practice of Medicine, 21* edition, B M Frier , M Fisher , Diabetes Mellitus . Nicholus AB, Nicki RC, Brian RW (ed.) 2010. Edinburg: Churchill Livingstone. p. .
Psoriasis as a human model of disease tostudy inflammatory atherogenesis. C L Harrington , A K Dey , R Yunus , A A Joshi , N N Mehta . Am. J. Physiol. Heart Circ. Physiol 2017. 312 p. .
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Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis. M A Gimbrone , Jr , G Garcia-Cardena . Circ. Res 2016. 118 p. . (PubMed)
impact of obesity and smoking on psoriasis presentation and management. M D Herron , M Hinckley , M S Hoffman , J Papenfuss , C B Hansen , K P Callis . Arch Dermatol 2005. 141 p. .
, M G Sorci-Thomas , M J Thomas , Microdomains . Inflammation, and Atherosclerosis.Circ. Res 2016. 118 p. . (PubMed)
Clinical improvement in psoriasis with treatment of associated hyperlipidemia. R Ghazizadeh , M Tosa , M Ghazizadeh . Am. J. Med. Sci 2011. 341 p. .
prevalence of metabolic syndrome in patients with psoriasis: a hospital-based casecontrol study. S H Gibson , Perry Ho ; Gisondi , P Tessari , G Conti , A Piaserco , S Schianchi , S Pesterico , A . AMA Arch Derm 1956. 2007. 74 (5) p. . (Bed Dermatol)

The Incidence of Lipoprotein Disorder in Patients with Psoriasis Attending in a Tertiary Care Hospital of Bangladesh

Table of contents

1.

Appendix A