Sunday, November 24, 2024
11/24/2024
Project Summary/Abstract This project is a novel study of psoriasis in individuals with Down syndrome (DS). Although clinical observations and existing literature contend that psoriasis is a common skin condition in DS, there is no supportive population-based research. Studies exploring disease severity and treatments are limited to case reports or small case series. There is likely an immunologic basis for this association: interferon (IFN) gamma is believed to be a significant cause of psoriasis and individuals with DS often have a hyperactive IFN pathway due to the triplication of chromosome 21. Improving our understanding of psoriasis in people with DS is paramount. We need to better understand the burden of disease across the age range, capture disease severity, and evaluate medical management. Psoriasis is not a condition limited to the skin, but rather a disease of systemic inflammation associated with multiple comorbidities, specifically cardiovascular disease and cardiometabolic risk factors including obesity, hypertension, dyslipidemia, type II diabetes, and metabolic syndrome. Recent guidelines by the American Heart Association and American College of Cardiology have identified psoriasis as an enhanced risk-inducing factor for atherosclerotic cardiovascular disease. Although these cardiovascular associations have been well established in the general population, the link between cardiometabolic risk and cardiovascular disease in individuals with DS and psoriasis is unknown. This potential association between psoriasis and cardiometabolic health is of particular interest since individuals with DS are considered protected against cardiovascular disease. Could psoriasis be an exception to the presumed resiliency in people with DS or reveal an exception to the established elevated risk in the general population? Either association would promote further investigation into the immunology and pathophysiology behind the association and prompt reevaluation of cardiovascular monitoring and medical management in patients with DS and psoriasis. To investigate this hypothesis, we propose utilizing Epic Cosmos, the largest integrated data platform of clinical health information in the United States with records from over 96,000 individuals with DS and approximately 2,000 patients with DS and psoriasis. We will use Epic Cosmos to 1) Evaluate the demographics, occurrence, treatment, and severity of psoriasis in DS patients and 2) Determine the association of cardiometabolic risk factors and cardiovascular events in DS patients with psoriasis and without. Skin conditions in DS should be considered a window into systemic health. We will establish the importance of thinking beyond “the visible” by examining cutaneous disorders, such as psoriasis, for their greater systemic impact. The innovative use of Cosmos will advance a novel and important translational methodology that can be leveraged for future projects within the DS research community.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
