Effect of Disease duration on Cardiac Autonomic Function tests in Psoriatic Patients

Neha Aggarwal; Jyotsna Shukla; Saroj Purohit

Volume : IX, Issue : VI, June - 2020

Effect of Disease duration on Cardiac Autonomic Function tests in Psoriatic Patients

Neha Aggarwal, Jyotsna Shukla, Saroj Purohit

Abstract :

Background: Psoriasis is a chronic, genetically determined and immune–mediated inflammatory disease of unknown etiology with a prevalence of 1–3% of human population worldwide and 0.44–2.8% in India. The literature reports an increased risk of cardiovascular diseases in Psoriatic patients. The present study was designed to explore the effect disease duration on autonomic functions in Psoriatic patients. Aim and Objectives: The present study was aimed to assess the autonomic status in patients with Psoriasis in the early stage of the disease and in patients with chronic Psoriasis with an extended purpose to explore the effect of the duration of the disease on the autonomic nervous system in Psoriatic patients aged 30–40 years as compared to age and sex matched healthy controls. Material and Methods: The present study was conducted on Psoriatic patients of both genders which were recruited from the Dermatology Department grouped in to new Psoriasis (n–40) (Less than one year) and old Psoriasis (n–40) patients group (more than one year), Age matched healthy subjects acted as controls(n=40). Parasympathetic function tests include E:I ratio, 30:15 ratio (lying to standing ratio) and Valsalva ratio; sympathetic function tests include blood pressure response to standing and blood pressure response to isometric hand grip. Result: Change in diastolic blood pressure during IHG exercise was significantly lower in chronic/old Psoriatic patients . Change in systolic blood pressure on immediate standing was higher in chronic/old Psoriatic group (p<0.05). E:I ratio, Valsalva ratio and 30:15 ratio were significantly decreased (p<0.05) in chronic/old Psoriastic patients as compared to the new patients. Conclusion: The deranged autonomic function tests in Psoriasis patients suggested definite autonomic dysfunction. Duration of disease seems to influence autonomic functions in patients with Psoriasis. Involvement of the parasympathetic system occurs in early phase of the disease and with increasing duration of the disease the sympathetic system also gets compromised. The cause of this progressive involvement could be due to the Psoriasis related alteration in the cardiovascular function due to the inflammatory mediators such as tumor necrosis factor–5 (TNF–5), IL–1, IL–12, IL–23, and IL–17. These inflammatory mediators act independently of conventional cardio vascular risk factor which promotes atherosclerosis .Therefore, routine autonomic function assessment of Psoriatic patients is necessary for a better prognosis.