Psoriasis (PsO) is a chronic, complex autoimmune disease characterized by erythematous, scaly patches over extensor aspects of skin and is associated with joint involvement in about one-third of patients.
An association between PsO and cardiovascular (CV) diseases has been a topic of dilemma, and many studies have shown an increased risk of cardiovascular morbidity in patients with PsO.
Coronary computed tomography angiography (CCTA) proved that the total plaque burden in PsO patients, which is non-calcified, is increased by 20% compared to healthy volunteers, so there is thickening of the coronary vessel wall before any symptoms appear [7-8].
Non-calcified plaque is the most common cause of plaque rupture and MI.
PsO is associated with low attenuation and positive remodelling, even at an early age; relatively that young PsO patients (46 years old) have a similar high-risk plaque presence as older hyperlipidemia patients (60 years old) . See Table 1.
In a study of moderate to severe PsO patients with a new biologic therapy (n = 89), compared to those refusing biologic therapy (n = 32), baseline and 12-month CCTA scans were compared for change in total plaque.
There was a significant change observed in inflammation (p <0.001) for biologic therapy; 5% and 7% reductions in total and non-calcified plaque burden, compared to a 2% and 5% increase in patients not receiving biologic therapy , see Table 2.
Additionally, there was a decrease in the necrotic core of 57% (the part of the plaque that ruptures) and a 33% progression in the patients without biologic treatment, see Table 3.
Exploratory analyses suggest that anti-TNF therapy had an insignificant effect on total plaque and non-calcified plaque burdens whereas anti-IL17 therapies were associated with a significant drop in these burdens, see Table 4.
These preliminary data are currently being investigated in randomised trials.
The lipid stream can become non-calcified plaque and with the inflammation observed in PsO patients, a necrotic core can form, and high-risk plaque is developed.
It is probably this plaque type causing myocardial infarction in PsO patients.
Biologic therapy may retard or even reverse this progression.
2. Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296:1735-41
3. Mehta NN, Yu Y, Pinnelas R, Krishnamoorthy P, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med. 2011;124:775.e1-6.
4. Mehta NN, Yu Y, Saboury B, et al. Systemic and vascular inflammation in patients with moderate to severe psoriasis as measured by [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT): a pilot study. Arch Dermatol. 2011;147:1031-9
5. Dey AK, Joshi AA, Chaturvedi A, et al. Association Between Skin and Aortic Vascular Inflammation in Patients With Psoriasis: A Case-Cohort Study Using Positron Emission Tomography/Computed Tomography. JAMA Cardiol. 2017;2:1013-1018
6. Mehta NN, Shin DB, Joshi AA, et al. Effect of 2 Psoriasis Treatments on Vascular Inflammation and Novel Inflammatory Cardiovascular Biomarkers: A Randomized Placebo-Controlled Trial. Circ Cardiovasc Imaging. 2018;11:e007394.
7. Ridker PM, Everett BM, Thuren T, et al., for the CANTOS Trial Group. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med 2017; 377:1119-1131.
8. Salahuddin T, Natarajan B, Playford MP, et al. Cholesterol efflux capacity in humans with psoriasis is inversely related to non-calcified burden of coronary atherosclerosis. Eur Heart J. 2015;36:2662-5.
9. Lerman JB, Joshi AA, Chaturvedi A, et al. Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study. Circulation. 2017;136:263-276.
10. Elnabawi YA, Dey AK, Goyal A, et al. Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study. Cardiovasc Res. 2019;115:721-728.
With this collection of summaries from selected presentations at SPIN 2019, and interviews with international experts, we hope to share with you some of the highlights of this year’s congress. The international network met … [ Read all ]