The Psoriasis, Atherosclerosis, and Cardiometabolic Disease Initiative (PACI)
Condition: Metabolic Disease; Cardiovascular Disease; Inflammation; Psoriasis
MeSH terms: Cardiovascular Diseases; Atherosclerosis; Psoriasis; Metabolic Diseases; Inflammation
Study type: Observational

Summary: 
      Background:

      - Cardiometabolic diseases are medical disorders that can occur together and affect the
      heart. They increase the risk of developing heart disease and diabetes. One disorder,
      psoriasis, is an inflammation that mostly affects the skin but can affect the entire body.
      Another disorder, atherosclerosis, is a process in which cholesterol is gradually deposited
      on the wall of arteries. This causes arteries to harden and become less flexible. Many cells
      that cause psoriasis also cause atherosclerosis. Researchers want to look at the relationship
      between cardiometabolic diseases and psoriasis.

      Objectives:

      - To study the relationship between psoriasis and cardiometabolic diseases.

      Eligibility:

      - Individuals at least 18 years of age who have psoriasis.

      Design:

        -  Participants will be screened with a physical exam and medical history.

        -  Participants will have up to seven outpatient visits over the 4 years. The first visit
           will be a screening visit. Visits 2 will be12 months after visit 1. Visits 3, 4, and 5,
           will be scheduled yearly for the next 3 years. If participants have a psoriasis flare
           with more severe symptoms, they may have an extra visit. Those who leave the study early
           will have a final visit with the full series of tests.

        -  At visits 1, 2,and 5, and any flare visits, participants will have a physical exam and
           medical history. They will provide blood and urine samples, as well as optional tissue
           biopsies. They will also have heart function tests. Imaging studies, as well as optional
           photographs of affected areas, will be performed. These tests will also be performed at
           the final visit.

        -  At visits 3 and 4, participants will have a physical exam and medical history. They will
           also provide blood and urine samples, and have heart function tests.
    

Detailed description: 
      Over the past two decades, inflammation has been identified as an important pathogenic
      process in cardiometabolic diseases (CMD) such atherosclerotic cardiovascular disease (CVD),
      dyslipidemia, insulin resistance, diabetes and obesity. However, mechanistic links between
      inflammation and these disease states in humans remain poorly understood. In this study, we
      propose to utilize psoriasis, a common, chronic inflammatory T-cell skin disease associated
      with increased CVD and CMD as a model to understand the effect of chronic inflammation on
      these diseases states. We will conduct a prospective cohort study to understand the effect of
      chronic inflammation on vascular and metabolic disease at the NIH Clinical Center.
      Furthermore, we will initiate a large scale collection of blood and skin from extramural
      sites to facilitate discovery of pathways involved in inflammatory modulation of CVD and CMD.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Any patient with a diagnosis of chronic plaque psoriasis, psoriatic arthritis, or pustular
        psoriasis will be considered for this protocol.
      
Keywords: Imaging; Cardiovascular Risk Factors; Inflammation; Lipoproteins; Metabolic Dysfunction; Natural History