Association of Biologic Therapy With Coronary Inflammation in Patients With Psoriasis as Assessed by Perivascular Fat Attenuation Index

Abstract

IMPORTANCE Psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events. Biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, but it is unclear whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries. OBJECTIVE To investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study performed from January 1, 2013, through March 31, 2019, analyzed changes in FAI in patients with moderate to severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline. EXPOSURES Biologic therapy for psoriasis. MAIN OUTCOMES AND MEASURES Perivascular FAI mapping was performed based on an established method by a reader blinded to patient demographics, visit, and treatment status. RESULTS Of the 134 patients (mean [SD] age, 51.1 [12.1] years; 84 [62.5%] male), most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate to severe skin disease. Of these patients, 82 received biologic psoriasis therapy (anti-tumor necrosis factor α, anti-interleukin [IL] 12/23, or anti-IL-17) for 1 year, and 52 did not receive any biologic therapy and were given topical or light therapy (control group). At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque. Biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI −71.22 HU [interquartile range (IQR), −75.85 to −68.

Potential role of perivascular adipose tissue in modulating atherosclerosis

“…Moreover, atherosclerotic plaque size and complex lipid core composition were positively correlated with PVAT volume and macrophage infiltration in a postmortem study of human subjects [13]. Thus, imaging of coronary PVAT holds promise as a non-invasive method to detect unstable coronary lesions [49,50].…”

“…Moreover, the PVAT FAI was observed to be beneficial in the risk stratification of patients without coronary artery disease who might benefit from intensive primary therapy to reduce their CVD risk. Elnabawi et al [50] studied the efficacy of novel biologic therapies (i.e. anti-TNF-α, anti-IL-17, and anti-IL12/23 therapy) in psoriasis patients.…”

“…They demonstrated for the first time that these types of therapies significantly reduced coronary inflammation as measured by the PVAT FAI in patients with and without coronary artery disease. Incorporation of the PVAT FAI into the standard coronary CT analysis may represent a promising method to quantify coronary inflammation and mark the beginning of primary or intensive secondary prevention strategies for those patients not identified by traditional CV risk factors [50].…”

A Belgian consensus on the definition of a treat‐to‐target outcome set in psoriasis management

“…As a systemic inflammatory disease, psoriasis is plagued by comorbidities, including psoriatic arthritis and cardiovascular diseases that may reduce life expectancy . Interestingly, recently Mehta's group showed that treatment with biologics could reduce coronary inflammation and healthcare resource consumption . Furthermore, duration of skin lesions has been linked to the risk of PsA, hypothesizing that early and aggressive intervention may prevent the development of PsA, and perhaps other comorbidities.…”

“…22 Interestingly, recently Mehta's group showed that treatment with biologics could reduce coronary inflammation and healthcare resource consumption. 23,24 Furthermore, duration of skin lesions has been linked to the risk of PsA, hypothesizing that early and aggressive intervention may prevent the development of PsA, 25 and perhaps other comorbidities. Moreover, we should also pay attention to the Cumulative Life Course Impairment that patients with psoriasis experience, including a heavy burden on their social and mental well-being over several years living with the disease.…”