{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:53:50Z","timestamp":1760151230431,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T00:00:00Z","timestamp":1644796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rheumato"],"abstract":"<jats:p>Psoriasis is a multifactorial disease, with many genetic risk factors, one of which seems to be the angiotensin-converting enzyme (ACE) insertion\/deletion (I\/D) polymorphism. ACE activity has been shown to be higher in psoriatic patients and it suggests an oxidative stress state, as seen in many cardiovascular disorders. We aimed to explore the association between ACE activity and polymorphisms and cardiovascular risk amongst psoriatic patients. We included 64 psoriatic patients and 1091 controls and compared ACE I\/D polymorphism genotype and serum activity for both groups. ACE genotypes were similar in psoriatic patients and controls. Notably, serum ACE activity was higher in psoriatic patients (19.09 \u00b1 2.86 U\/mL) compared to controls (11.85 \u00b1 0.40 U\/mL), p = 0.015. Non-HDL cholesterol was significantly lower in II polymorphism (p = 0.037). Psoriatic activity (PASI) was associated with a higher cardiovascular risk estimated by lower HDL concentrations (r = \u22120.496, p = 0.007), and higher triglyceride levels (r = 0.421, p = 0.020) and TC\/HDL and LDL\/HDL ratios (r = 0.612, p &lt; 0.001 and r = 0.437, p = 0.023, respectively). Patients with psoriasis have higher ACE activity levels, independent of ACE genotype. Moreover, disease activity correlated with cardiovascular risk. This could support the eventual role of ACE as a possible biomarker for disease severity and cardiovascular risk in psoriasis patients.<\/jats:p>","DOI":"10.3390\/rheumato2010003","type":"journal-article","created":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T20:58:03Z","timestamp":1644872283000},"page":"15-23","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Angiotensin-Converting Enzyme Activity May Predict Disease Severity in Psoriasis"],"prefix":"10.3390","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8312-4532","authenticated-orcid":false,"given":"Matilde","family":"Bandeira","sequence":"first","affiliation":[{"name":"Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universit\u00e1rio Lisboa Norte, Lisbon Academic Medical Centre, 1649-035 Lisbon, Portugal"},{"name":"Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon Academic Medical Centre, 1649-035 Lisbon, Portugal"}]},{"given":"\u00c2ngela","family":"Gil","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Gen\u00e9tica, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"},{"name":"Instituto de Investiga\u00e7\u00e3o Cient\u00edfica Bento da Rocha Cabral, 1250-047 Lisbon, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental-Ecogen\u00e9tica e Sa\u00fade Humana, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"}]},{"given":"Ana Carolina","family":"Santos","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Gen\u00e9tica, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"},{"name":"Instituto de Investiga\u00e7\u00e3o Cient\u00edfica Bento da Rocha Cabral, 1250-047 Lisbon, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental-Ecogen\u00e9tica e Sa\u00fade Humana, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5603-9436","authenticated-orcid":false,"given":"Vasco C.","family":"Rom\u00e3o","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universit\u00e1rio Lisboa Norte, Lisbon Academic Medical Centre, 1649-035 Lisbon, Portugal"},{"name":"Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon Academic Medical Centre, 1649-035 Lisbon, Portugal"}]},{"given":"M\u00e1rio Rui","family":"Mascarenhas","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Ambiental-Ecogen\u00e9tica e Sa\u00fade Humana, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"},{"name":"Cl\u00ednica de Endocrinologia, Diabetes e Metabolismo de Lisboa, 1050-017 Lisbon, Portugal"}]},{"given":"Paulo","family":"Filipe","sequence":"additional","affiliation":[{"name":"Dermatology Department, Centro Hospitalar Universit\u00e1rio Lisboa Norte, 1649-035 Lisbon, Portugal"},{"name":"Unidade Curricular de Dermatologia, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"},{"name":"Dermatology Research Unit, Instituto de Medicina Molecular, Lisbon Academic Medical Centre, 1649-035 Lisbon, Portugal"}]},{"given":"Jo\u00e3o Eurico","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universit\u00e1rio Lisboa Norte, Lisbon Academic Medical Centre, 1649-035 Lisbon, Portugal"},{"name":"Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon Academic Medical Centre, 1649-035 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5773-5687","authenticated-orcid":false,"given":"Manuel","family":"Bicho","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Gen\u00e9tica, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"},{"name":"Instituto de Investiga\u00e7\u00e3o Cient\u00edfica Bento da Rocha Cabral, 1250-047 Lisbon, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental-Ecogen\u00e9tica e Sa\u00fade Humana, Faculdade de Medicina da Universidade de Lisboa, 1649-035 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ii18","DOI":"10.1136\/ard.2004.033217","article-title":"Psoriasis: Epidemiology, clinical features, and quality of life","volume":"64","author":"Langley","year":"2005","journal-title":"Ann. Rheum. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1056\/NEJMra0804595","article-title":"Psoriasis","volume":"361","author":"Nestle","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/0009-8981(85)90165-2","article-title":"Serum angiotensin converting enzyme activity in patients with psoriasis","volume":"153","author":"Ryder","year":"1985","journal-title":"Clin. Chim. Acta"},{"key":"ref_4","first-page":"1215","article-title":"Serum and tissue angiotensin converting enzyme in patients with psoriasis","volume":"32","author":"Alendar","year":"2008","journal-title":"Coll. Antropol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1111\/j.1365-4632.2009.04245.x","article-title":"Lack of association between angiotensin I-converting enzyme insertion\/deletion polymorphism and psoriasis or psoriatic arthritis in Spain","volume":"48","author":"Alvarez","year":"2009","journal-title":"Int. J. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1111\/j.1365-2133.2006.07716.x","article-title":"Association between the insertion\/deletion polymorphism of the angiotensin I-converting enzyme gene and risk for psoriasis in a Chinese population in Taiwan","volume":"156","author":"Chang","year":"2007","journal-title":"Br. J. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/1470320313494433","article-title":"Angiotensin-converting enzyme insertion\/deletion polymorphism and susceptibility to psoriasis in a Chinese population","volume":"15","author":"Yang","year":"2013","journal-title":"J. Renin-Angiotensin-Aldosterone Syst."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1111\/j.1365-2133.2004.06148.x","article-title":"Association of insertion\/deletion polymorphism of the angiotensin-converting enzyme gene with psoriasis","volume":"151","author":"Erbagci","year":"2004","journal-title":"Br. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1111\/j.1600-0625.2007.00620.x","article-title":"The angiotensin-converting enzyme insertion\/deletion and the endothelin -134 3A\/4A gene polymorphisms in patients with chronic plaque psoriasis","volume":"16","author":"Weger","year":"2007","journal-title":"Exp. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jdermsci.2007.08.005","article-title":"Assessment of insertion\/deletion polymorphism of the angiotensin converting enzyme gene in psoriasis","volume":"49","author":"Veletza","year":"2008","journal-title":"J. Dermatol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1093\/nar\/20.6.1433-a","article-title":"PCR detection of the insertion\/deletion polymorphism of the human angiotensin converting enzyme gene (DCP1) (dipeptidyl carboxypeptidase 1)","volume":"20","author":"Rigat","year":"1992","journal-title":"Nucleic Acids Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1172\/JCI114844","article-title":"An insertion\/deletion polymorphism in the angiotensin I-converting enzyme gene accounting for half the variance of serum enzyme levels","volume":"86","author":"Rigat","year":"1990","journal-title":"J. Clin. Investig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/S1357-2725(02)00278-9","article-title":"Towards the understanding of the local hematopoietic bone marrow renin-angiotensin system","volume":"35","author":"Haznedaroglu","year":"2003","journal-title":"Int. J. Biochem. Cell Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1161\/01.RES.0000217340.40936.53","article-title":"Signaling by the Angiotensin-Converting Enzyme","volume":"98","author":"Fleming","year":"2006","journal-title":"Circ. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1042\/CS20080157","article-title":"The role of the renin\u2013angiotensin\u2013aldosterone system in cardiovascular progenitor cell function","volume":"116","author":"Qian","year":"2009","journal-title":"Clin. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1161\/HYPERTENSIONAHA.110.167171","article-title":"Angiotensin II Binding to Angiotensin I\u2013Converting Enzyme Triggers Calcium Signaling","volume":"57","author":"Alvarenga","year":"2011","journal-title":"Hypertension"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1001\/jamadermatol.2013.5015","article-title":"Psoriasis severity and the prevalence of major medical comorbidity","volume":"149","author":"Yeung","year":"2013","journal-title":"JAMA Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00296-016-3487-2","article-title":"Updates on cardiovascular comorbidities associated with psoriatic diseases: Epidemiology and mechanisms","volume":"37","author":"Yim","year":"2016","journal-title":"Rheumatol. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1150.e1","DOI":"10.1016\/j.amjmed.2009.06.021","article-title":"Comorbidities in patients with psoriasis","volume":"122","author":"Gottlieb","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1146\/annurev-immunol-032713-120225","article-title":"Immunology of psoriasis","volume":"32","author":"Lowes","year":"2014","journal-title":"Annu. Rev. Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s00281-015-0539-8","article-title":"Update on psoriasis immunopathogenesis and targeted immunotherapy","volume":"38","author":"Mahil","year":"2015","journal-title":"Semin. Immunopathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/j.1600-0625.2011.01308.x","article-title":"A tale of two plaques: Convergent mechanisms of T-cell-mediated inflammation in psoriasis and atherosclerosis","volume":"20","author":"Armstrong","year":"2011","journal-title":"Exp. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1111\/j.1468-3083.2007.02260.x","article-title":"The lipid profile in psoriasis: A controlled study","volume":"21","author":"Akhyani","year":"2007","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2007\/78454","article-title":"Accumulation of oxidized low-density lipoprotein in psoriatic skin and changes of plasma lipid levels in psoriatic patients","volume":"2007","author":"Tekin","year":"2006","journal-title":"Mediat. Inflamm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.jaad.2005.11.1079","article-title":"Psoriasis is associated with lipid abnormalities at the onset of skin disease","volume":"54","author":"Mallbris","year":"2006","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jaad.2006.08.040","article-title":"Prevalence of cardiovascular risk factors in patients with psoriasis","volume":"55","author":"Neimann","year":"2006","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/j.metabol.2004.02.007","article-title":"Serum tumor necrosis factor-\u03b1 levels and components of the metabolic syndrome in obese adolescents","volume":"53","author":"Moon","year":"2004","journal-title":"Metabolism"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.jaci.2005.02.023","article-title":"Adipose tissue, adipokines, and inflammation","volume":"115","author":"Fantuzzi","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6184","DOI":"10.3390\/ijms15046184","article-title":"Obesity and its metabolic complications: The role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease","volume":"15","author":"Jung","year":"2014","journal-title":"Int. J. Mol. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.atherosclerosis.2012.06.068","article-title":"Abnormal lipoprotein particles and cholesterol efflux capacity in patients with psoriasis","volume":"224","author":"Mehta","year":"2012","journal-title":"Atherosclerosis"},{"key":"ref_31","first-page":"285","article-title":"Aortic vascular inflammation in psoriasis is associated with HDL particle size and concentration: A pilot study","volume":"2","author":"Yu","year":"2012","journal-title":"Am. J. Cardiovasc. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2662","DOI":"10.1093\/eurheartj\/ehv339","article-title":"Cholesterol efflux capacity in humans with psoriasis is inversely related to non-calcified burden of coronary atherosclerosis","volume":"36","author":"Salahuddin","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"209","DOI":"10.4331\/wjbc.v6.i3.209","article-title":"Inflammation, oxidative stress and renin angiotensin system in atherosclerosis","volume":"6","author":"Husain","year":"2015","journal-title":"World J. Biol. Chem."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1152\/physrev.00047.2003","article-title":"Role of oxidative modifications in atherosclerosis","volume":"84","author":"Stocker","year":"2004","journal-title":"Physiol. Rev."},{"key":"ref_35","first-page":"1","article-title":"Angiotensin-converting enzyme insertion\/deletion polymorphism, 24-h blood pressure profile and left ventricular hypertrophy in hypertensive individuals: A cross-sectional study","volume":"20","author":"Pereira","year":"2015","journal-title":"Eur. J. Med. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.ihj.2012.08.005","article-title":"Polymorphism of ACE gene as the genetic predisposition of coronary artery disease in Eastern India","volume":"64","author":"Dhar","year":"2012","journal-title":"Indian Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00403-010-1080-1","article-title":"Definition of treatment goals for moderate to severe psoriasis: A European consensus","volume":"303","author":"Mrowietz","year":"2010","journal-title":"Arch. Dermatol. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1161\/01.CIR.92.6.1387","article-title":"Angiotensin-converting enzyme in the human heart","volume":"92","author":"Danser","year":"1995","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.cell.2008.02.038","article-title":"Epidermal sensing of oxygen is essential for systemic hypoxic response","volume":"133","author":"Boutin","year":"2008","journal-title":"Cell"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1161\/01.HYP.0000251865.35728.2f","article-title":"Angiotensin-(1-7) through receptor mas mediates endothelial nitric oxide synthase activation via akt-dependent pathways","volume":"49","author":"Sampaio","year":"2007","journal-title":"Hypertension"},{"key":"ref_41","first-page":"757","article-title":"Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention","volume":"5","author":"Pallardo","year":"2009","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"641","DOI":"10.7326\/0003-4819-121-9-199411010-00002","article-title":"Cholesterol and coronary heart disease: Predicting risks by levels and ratios","volume":"121","author":"Kinosian","year":"1994","journal-title":"Ann. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2165\/00129784-200707010-00004","article-title":"Management of dyslipidemia in the metabolic syndrome","volume":"7","author":"Ascaso","year":"2007","journal-title":"Am. J. Cardiovasc. Drugs"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.1161\/01.CIR.0000146339.57154.9B","article-title":"multivariate assessment of lipid parameters as predictors of coronary heart disease among postmenopausal women","volume":"110","author":"Shai","year":"2004","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.amjcard.2006.05.024","article-title":"A Population-based, cross-sectional comparison of lipid-related indexes for symptoms of atherosclerotic disease","volume":"98","author":"Hsia","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/00005344-200405000-00018","article-title":"Gender differences in angiotensin-converting enzyme (ACE) activity and inhibition by enalaprilat in healthy volunteers","volume":"43","author":"Zapater","year":"2004","journal-title":"J. Cardiovasc. Pharmacol."}],"container-title":["Rheumato"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2674-0621\/2\/1\/3\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:19:06Z","timestamp":1760134746000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2674-0621\/2\/1\/3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,14]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["rheumato2010003"],"URL":"https:\/\/doi.org\/10.3390\/rheumato2010003","relation":{},"ISSN":["2674-0621"],"issn-type":[{"type":"electronic","value":"2674-0621"}],"subject":[],"published":{"date-parts":[[2022,2,14]]}}}