Aortic Vascular Inflammation Associated With Coronary Artery Disease in Psoriasis

Aortic vascular inflammation is a potential precursor to early coronary artery disease, according to a study published in the Journal of the American Medical Association Cardiology.

Researchers in this cross-sectional study evaluated patients with psoriasis by using fludeoxyglucose F 18 positron emission tomography/computed tomography to examine aortic vascular inflammation and coronary computed tomography angiography to examine the components of coronary artery disease, such as total and noncalcified coronary plaque burden, luminal stenosis, and high-risk plaques.

Of the total 215 participants, 59% were men, the mean age was 50.4 years, the mean psoriasis severity index score was 5.7, and the mean psoriasis duration was 20 years. The participants’ body characteristics included an average body mass index of 29.6 and a total cholesterol score of 183 mg/dL, while 48% suffered from dyslipidemia and 11% had diabetes.

Overall, patients had high aortic vascular inflammation, with a target-to-background ratio of 1.70 and a total plaque burden of 1.14 mm².  In addition, 82 patients had greater than 25% luminal stenosis and 57 patients had high-risk plaques in a coronary artery. Patients with high target-to-background scores (mean=1.89) had a higher body mass index (P <.001), a higher atherosclerotic cardiovascular disease risk (P <.001), a higher insulin resistance, a higher total plaque burden (P <.001), a higher noncalcified coronary plaque burden (P <.001), an increase in luminal stenosis (P <.001), and an increase in high-risk plaques (P =.02) when compared to patients with lower target-to-background scores. In fully adjusted models, aortic vascular inflammation was associated with total plaque burden (P <.001), noncalcified coronary plaque burden (P<.001), luminal stenosis (P =.007), and high-risk plaques (P =.03).

Future studies need to evaluate the causation of cardiovascular outcomes over a longer follow-up time frame and the effects of statins and other medication on these findings. Other imaging technologies could assess inflammation in other manners, which could elaborate on these results.

In conclusion, it appears that aortic vascular inflammation impacts early cardiovascular disease by affecting plaque burdens. This study examined the inflammatory issues surrounding psoriasis, but it may be generalizable to other inflammatory diseases.

Reference

Joshi AA, Lerman JB, Dey AK, et al. Association between aortic vascular inflammation and coronary artery plaque characteristics in psoriasis [published online September 12, 2018]. JAMA Cardiol. doi: 10.1001/jamacardio.2018.2769