Treatment of psoriasis with biologic agents may confer an added benefit of reducing the risk for future cardiovascular events by helping the body reduce lipid-rich necrotic core (LRNC), a histopathologic correlate of low-attenuation plaque, study finding published in Circulation: Cardiovascular Imaging suggests.
In this prospective, observational study, investigators from the National Heart, Lung, and Blood Institute conducted coronary computed tomography angiography imaging in 209 consecutive biologic-naïve patients with psoriasis to evaluate changes in LRNC with biologic therapy over a 1-year period. Patients were recruited as part of the Psoriasis Atherosclerosis and Cardiometabolic disease Initiative cohort.
A total of 124 patients initiated biologic therapy. The mean age of the cohort at baseline was 49.6±12.7 years. Overall, patients were considered at low cardiovascular risk based on the median Framingham risk score (median, 1.9), and all patients had mild to moderate psoriasis with a median PASI of 6.
At baseline, positive associations were observed between LRNC and being male (β [standardized β]=0.13; 95% CI, 0.01–0.24; P =.032), hypertension status (β=0.19; 95% CI, 0.07–0.30; P =.002), Framingham risk score (β=0.12; 95% CI, 0.00–0.24; P =.045), and psoriasis severity (β=0.13; 95% CI, 0.01–0.26; P =.029).
Patients who received biologic therapy had a significant reduction in their LRNC from baseline to 1 year (3.12 vs 2.97 mm2, respectively; P =.028). Patients who did not receive biologic therapy over the 1-year period had no significant change in LRNC (3.12 vs 3.34 mm2; P =.06).
In an analysis that compared patients treated with biologic therapy with patients not treated with biologic therapy, those treated with these therapies had a significant change in the LRNC during the 1 year (ΔLRNC, −0.22 vs 0.14 mm2, respectively; P =.004). This difference remained significant in an analysis adjusted for cardiovascular risk factors and psoriasis severity (β=−0.09; 95% CI, −0.01 to −0.18; P =.033).
Limitations of this study included the relatively short follow-up period as well as the lack of a randomized design that included a placebo or control against a biologic therapy group.
Despite these limitations, the investigators of the study indicate that their “findings highlight the potential importance of treating in vivo systemic inflammation to reduce cardiovascular disease risk in psoriasis.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Choi H, Uceda DE, Dey AK, et al. Treatment of psoriasis with biologic therapy is associated with improvement of coronary artery plaque lipid-rich necrotic core: Results from a prospective, observational study. Circ Cardiovasc Imaging. doi:10.1161/CIRCIMAGING.120.011199