Does Lichen Planus Disease Increase Cardiovascular Risk?

Abstract

Background and Aim: Lichen Planus (LP) is assumed to be closely related to dyslipidaemia. Several cytokines involved in LP pathogenesis, could explain its association with dyslipidaemia. Furthermore, chronic inflammation has been found to play an important role in the development of cardiovascular risk factors. The aim of our study is to evaluate the inflammation markers, Neutrophil/ Lymphocyte Ratio (NLR), and coagulation markers MPV, MPV/ platelet ratio and other laboratory parameters.

Materials and Methods: Fifty seven patients with diagnosis of LP according to clinical and histopathologic findings, as well as 40 age-sex matched controls were recruited to the study. The control group were selected from people without any systemic disease, medication or infection in the previous month. The laboratory parameters were retrospectively scanned. Differences between patients and controls were evaluated, depending on data type, using parametric or nonparametric tests, for independent or paired samples. A p-value < 0.05 was considered significant.

Results: There was not a statistically significant difference in NLR values between patient and control groups whereas difference was significant in MPV/ platelet rate (p=0.01).

Conclusion: The patients with LP were found to have higher MPV/ platelet ratio compared to the control group independent of age, sex, disease duration and clinical types.

Keywords: Lichen Planus; Cardiovascular Risk; MPV; MPV/Platelet Ratio

Introduction

Lichen planus (LP) is a chronic inflammatory disease that affects the skin, appendages and mucous membranes. LP occurs mostly over 45 years old, and is more common among women [1]. The pathogenesis of LP is considered multifactorial, especially the evidence indicates that an imbalance of immunologic cellular reactivity is central [2,3]. Although LP is an immune-mediated disease, the keratinocytes are known to release more cytokines (pro-inflammatory and anti-inflammatory) (TNF-a, IL-2, IL-4, IL-6 and IL-10) during the lymphocytotoxic process [3,4]. Additionally, the dyslipidemia seen in these subjects may be attributed to these proinflammatory cytokines. The recent studies reported an association between LP and dyslipidaemia [5-8]. They suggested chronic inflammation may result with dyslipidemia. Dyslipidaemia is a well-established cardiovascular risk factor for coronary artery disease, stroke, myocardial infarction and cardiovascular deaths [9,10]. Recent advances in clinical laboratory techniques have opened new horizons for a better understanding of the role of platelets in thrombosis, immunity, inflammation and angiogenesis. Blood platelets participate actively in immune-inflammatory processes [11,12]. Immune inflammatory processes associated with skin diseases could induce platelet activation, which, in turn, would contribute to acceleration and modulation of these processes. Mean Platelet Volume (MPV), an indicator of platelet activation, is a newly emerging risk factor for atherothrombosis. According to our knowledge, the MPV/platelet ratio is superior to the MPV alone in predicting long-term mortality [13,14]. As LP is a chronic inflammatory disease, LP patients may have increased cardiovascular risk factors in the long term. The aim of our study is to evaluate the inflammation markers, Neutrophil/ Lymphocyte Ratio (NLR), and coagulation markers MPV, MPV/ platelet ratio and other laboratory parameters.

Materials and Methods

The study was performed by the dermatology unit of Afyon Kocatepe University, after obtaining the approval of the local ethical committee (the committee’s approval number of ethics: 2015/04-30). In our study, 57 patients with diagnosis of LP according to clinical and histopathologic findings, as well as 40 age-sex matched controls were recruited to the study. The control group was selected from people without any systemic disease, medication or infection in the previous month.

The laboratory parameters were retrospectively scanned. Differences between patients and controls were evaluated, depending on data type, using parametric or nonparametric tests, for independent or paired samples. A p-value < 0.05 was considered significant.

Results

Of the 57 patients, 35 were women and 22 were men. Of the 40 controls 22 were women and 18 were men. There were 40 cutaneous LP, 7 oral LP, 2 lichen planopilaris, 8 cutaneous plus oral LP. LP disease duration in Table 1. The five patients with LP were positive HBV antigen, and 2 patients with LP were positive HCV antigen. There was not a statistically significant difference in NLR values between patient and control groups whereas difference was significant in MPV/platelet rate (p=0.01). We reported results of laboratory parameters and demographic data of patients and controls in Table 1.

  

    
N 
    
Patients 
    
Controls 
    
P values 
  
  

    
Cutaneous LP*:    40
      
Oral LP: 7
      
lichen planopilaris: 2
      
Oral+ Cutaneous    LP: 8
      
Total: 57
    
40
    
-
  
  

    
Age 
    
38.05 + 12.28
    
36.44 + 13.06
    
0.05>
  
  

    
Sex 
    
F: 35, M: 22
    
F: 22, M: 18
    
0.05>
  
  

    
Disease Duration 
      
0-1 month 
      
2-6 month 
      
6 month< 
    
 
      
n:1
      
n:11
      
n:45
    
-
    
-
  
  

    
MPV** 
    
9.61 + 0.22
    
8.65 + 0.32
    
0.05>
  
  

    
MPV/ platelet 
    
0.04 + 0.02
    
0.03 + 0.01
    
0.018
  
  

    
NLR*** 
    
2.21 + 1.01
    
2.07 + 0.67
    
0.05>
  
  

    
*LP:    Lichen Planus; **MPV: Mean Platelet    volume; ***NLR: Neutrophil    lymphocyte ratio.
      
 
  

Table 1:  The laboratory parameters and demographic datas of patients and
controls.