Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.

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  • Additional Information
    • Affiliation:
      National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
      Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, CA
      DermAssociates, Silver Spring, MD
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Background: Psoriasis, a chronic inflammatory disease associated with an accelerated risk of myocardial infarction, provides an ideal human model to study inflammatory atherogenesis in vivo. We hypothesized that the increased cardiovascular risk observed in psoriasis would be partially attributable to an elevated subclinical coronary artery disease burden composed of noncalcified plaques with high-risk features. However, inadequate efforts have been made to directly measure coronary artery disease in this vulnerable population. As such, we sought to compare total coronary plaque burden and noncalcified coronary plaque burden (NCB) and high-risk plaque (HRP) prevalence between patients with psoriasis (n=105), patients with hyperlipidemia eligible for statin therapy under National Cholesterol Education Program-Adult Treatment Panel III guidelines (n=100) who were ≈10 years older, and healthy volunteers without psoriasis (n=25).Methods: Patients underwent coronary computed-tomography angiography for total coronary plaque burden and NCB quantification and HRP identification, defined as low attenuation (<30 hounsfield units), positive remodeling (>1.10), and spotty calcification. A consecutive sample of the first 50 patients with psoriasis was scanned again 1 year after therapy.Results: Despite being younger and at lower traditional risk than patients with hyperlipidemia, patients with psoriasis had increased NCB (mean±SD: 1.18±0.33 versus 1.11±0.32, P=0.02) and similar HRP prevalence (P=0.58). Furthermore, compared to healthy volunteers, patients with psoriasis had increased total coronary plaque burden (1.22±0.31 versus 1.04±0.22, P=0.001), NCB (1.18±0.33 versus 1.03±0.21, P=0.004), and HRP prevalence beyond traditional risk (odds ratio, 6.0; 95% confidence interval, 1.1-31.7; P=0.03). Last, among patients with psoriasis followed for 1 year, improvement in psoriasis severity was associated with improvement in total coronary plaque burden (β=0.45, 0.23-0.67; P<0.001) and NCB (β=0.53, 0.32-0.74; P<0.001) beyond traditional risk factors.Conclusions: Patients with psoriasis had greater NCB and increased HRP prevalence than healthy volunteers. In addition, patients with psoriasis had elevated NCB and equivalent HRP prevalence as older patients with hyperlipidemia. Last, modulation of target organ inflammation (eg, skin) was associated with an improvement in NCB at 1 year, suggesting that control of remote sites of inflammation may translate into reduced coronary artery disease risk.
    • Journal Subset:
      Biomedical; Peer Reviewed; USA
    • ISSN:
      0009-7322
    • MEDLINE Info:
      PMID: NLM28483812 NLM UID: 0147763
    • Grant Information:
      N01HC95159/HL/NHLBI NIH HHS/United States; Z99 HL999999//Intramural NIH HHS/United States; N01HC95168/HL/NHLBI NIH HHS/United States; ZIA HL006193-02//Intramural NIH HHS/United States; R01 HL069905/HL/NHLBI NIH HHS/United States
    • Publication Date:
      20180724
    • Publication Date:
      20191011
    • Accession Number:
      http://dx.doi.org/10.1161/CIRCULATIONAHA.116.026859
    • Accession Number:
      124164470
  • Citations
    • ABNT:
      LERMAN, J. B. et al. Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study. Circulation, [s. l.], v. 136, n. 3, p. 263–276, 2017. DOI 10.1161/CIRCULATIONAHA.116.026859. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ccm&AN=124164470&custid=s6224580. Acesso em: 6 abr. 2020.
    • AMA:
      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(3):263-276. doi:10.1161/CIRCULATIONAHA.116.026859.
    • APA:
      Lerman, J. B., Joshi, A. A., Chaturvedi, A., Aberra, T. M., Dey, A. K., Rodante, J. A., Salahuddin, T., Chung, J. H., Rana, A., Teague, H. L., Wu, J. J., Playford, M. P., Lockshin, B. A., Chen, M. Y., Sandfort, V., Bluemke, D. A., & Mehta, N. N. (2017). Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study. Circulation, 136(3), 263–276. https://doi.org/10.1161/CIRCULATIONAHA.116.026859
    • Chicago/Turabian: Author-Date:
      Lerman, Joseph B., Aditya A. Joshi, Abhishek Chaturvedi, Tsion M. Aberra, Amit K. Dey, Justin A. Rodante, Taufiq Salahuddin, et al. 2017. “Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.” Circulation 136 (3): 263–76. doi:10.1161/CIRCULATIONAHA.116.026859.
    • Harvard:
      Lerman, J. B. et al. (2017) ‘Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study’, Circulation, 136(3), pp. 263–276. doi: 10.1161/CIRCULATIONAHA.116.026859.
    • Harvard: Australian:
      Lerman, JB, Joshi, AA, Chaturvedi, A, Aberra, TM, Dey, AK, Rodante, JA, Salahuddin, T, Chung, JH, Rana, A, Teague, HL, Wu, JJ, Playford, MP, Lockshin, BA, Chen, MY, Sandfort, V, Bluemke, DA & Mehta, NN 2017, ‘Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study’, Circulation, vol. 136, no. 3, pp. 263–276, viewed 6 April 2020, .
    • MLA:
      Lerman, Joseph B., et al. “Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.” Circulation, vol. 136, no. 3, July 2017, pp. 263–276. EBSCOhost, doi:10.1161/CIRCULATIONAHA.116.026859.
    • Chicago/Turabian: Humanities:
      Lerman, Joseph B., Aditya A. Joshi, Abhishek Chaturvedi, Tsion M. Aberra, Amit K. Dey, Justin A. Rodante, Taufiq Salahuddin, et al. “Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.” Circulation 136, no. 3 (July 18, 2017): 263–76. doi:10.1161/CIRCULATIONAHA.116.026859.
    • Vancouver/ICMJE:
      Lerman JB, Joshi AA, Chaturvedi A, Aberra TM, Dey AK, Rodante JA, et al. Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study. Circulation [Internet]. 2017 Jul 18 [cited 2020 Apr 6];136(3):263–76. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ccm&AN=124164470&custid=s6224580