Noncalcified, High-Risk Coronary Plaque Burden Increased With Psoriasis

Psoriasis may be associated with a greater noncalcified coronary plaque burden and increased high-risk plaque, according to a study published in Circulation.

Researchers from the National Heart, Lung, and Blood Institute evaluated 3 patient cohorts: psoriasis (n=105), hyperlipidemia without psoriasis (n=100), and healthy volunteers who did not have psoriasis or any other underlying inflammatory disease (n=25). The mean age of patients with psoriasis was 50.4 years and they had moderate to severe skin disease. Patients with hyperlipidemia had a mean age of 61.2 years and the mean age of the healthy volunteers was 47.7 years.

Participants underwent coronary computed-tomography angiography (CCTA) for total coronary plaque burden and noncalcified coronary plaque burden quantification, as well as detection of high-risk plaque. After 1 year of therapy, a consecutive sample of the first 50 patients with psoriasis was scanned again.

The noncalcified coronary plaque burden was higher in patients with psoriasis (1.18±0.33) than in patients with hyperlipidemia (1.11±0.32;

P =.02). Patients with psoriasis also had an increased total coronary plaque burden (1.22±0.31) compared with healthy volunteers (1.04±0.22; P =.001) and high-risk plaque beyond traditional risk (odds ratio, 6.0; 95% CI, 1.1-31.7; P =.03).

Decreasing psoriasis severity was associated with improvements in total coronary plaque burden (β=0.45; 0.23-0.67; P <.001) and noncalcified coronary plaque burden (β=0.53; 0.32-0.74; P <.001) beyond traditional risk factors at 1 year.

The researchers concluded that patients with psoriasis should be screened for cardiovascular risk factors, especially when the disease is severe.

Study Limitations

• Small sample size, particularly a disproportionately small cohort of healthy volunteers
• Follow-up data was only available for a subset of patients for a short duration of 1 year
• CCTA scans were evaluated by a single-blinded reader, but good intra- and interexaminer reliability was present in a subgroup of patients whose scans were read by 2 separate readers
• The consecutive sample that was followed for psoriasis improvement was not randomized nor was it stratified by treatment; therefore, results should be interpreted with caution
• Residual confounding may have occurred

Reference

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. doi:10.1161/CIRCULATIONAHA.116.026859