Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study

Elnabawi, Youssef; Dey, Amit; Goyal, Aditya; Groenendyk, Jacob; Chung, Jonathan; Belur, Agastya D.; Rodante, Justin; Harrington, Charlotte; Teague, Heather; Baumer, Yvonne; Keel, Andrew; Playford, Martin P.; Sandfort, Veit; Chen, Marcus Y; Lockshin, Benjamin; Gelfand, Joel M.; Bluemke, David A.; Mehta, Nehal N.

doi:10.1093/cvr/cvz009

Cited by 197 publications

(168 citation statements)

References 33 publications

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“…Specifically, lengthier biologic DMARD treatment reduced the likelihood of noncalcified plaque progression, the earliest histologic atherosclerotic lesion discernible on coronary CT angiography. Biologic therapies were similarly shown to selectively influence lipid‐rich, soft plaque volume in patients with psoriasis . Moreover, we showed that lengthier biologic DMARD exposure appeared to prevent maturation and remodeling of such plaques, as evidenced by the lower risk of progressive calcification independent of inflammation, duration of statin exposure, and total prednisone dose.…”

Section: Discussionmentioning

confidence: 66%

Impact of Cumulative Inflammation, Cardiac Risk Factors, and Medication Exposure on Coronary Atherosclerosis Progression in Rheumatoid Arthritis

Karpouzas

Ormseth

Hernández

et al. 2020

Arthritis & Rheumatology

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Objective To explore incidence and progression of coronary atherosclerosis and identify determinants in patients with rheumatoid arthritis (RA). We specifically evaluated the impact of inflammation, cardiac risk factors, duration of medication exposure, and their interactions on coronary plaque progression. Methods One hundred one participants with baseline coronary computed tomography angiography findings underwent follow‐up assessment a mean ± SD of 83 ± 3.6 months after baseline. Plaque burden was reported as the segment involvement score (describing the number of coronary segments with plaque) and the segment stenosis score (characterizing the cumulative plaque stenosis over all evaluable segments). Plaque composition was classified as noncalcified, mixed, or calcified. Coronary artery calcium (CAC) was quantified using the Agatston method. Results Total plaque increased in 48% of patients, and progression was predicted by older age, higher cumulative inflammation, and total prednisone dose (P < 0.05). CAC progressors were older, more obese, hypertensive, and had higher cumulative inflammation compared to nonprogressors (P < 0.05). Longer exposure to biologics was associated with lower likelihood of noncalcified plaque progression, lesion remodeling, and constrained CAC change in patients without baseline calcification, independent of inflammation, prednisone dose, or statin exposure (all P < 0.05). Longer statin treatment further restricted noncalcified plaque progression and attenuated the effect of inflammation on increased plaque and CAC (P < 0.05). Stringent systolic blood pressure (BP) control further weakened the effect of inflammation on total plaque progression. Conclusion Inflammation was a consistent and independent predictor of coronary atherosclerosis progression in RA. It should therefore be specifically targeted toward mitigating cardiovascular risk. Biologic disease‐modifying antirheumatic drugs, statins, and BP control may further constrain plaque progression directly or indirectly.

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Section: Discussionmentioning

confidence: 66%

Impact of Cumulative Inflammation, Cardiac Risk Factors, and Medication Exposure on Coronary Atherosclerosis Progression in Rheumatoid Arthritis

Karpouzas

Ormseth

Hernández

et al. 2020

Arthritis & Rheumatology

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“…Interestingly, psoriasis patients receiving anti-TNF treatment exhibited decreased vascular inflammation and a gender-dependent effect on carotid plaque progression after 1 year (88). Further evidence of the effect of anti-IL-17A treatment on cardiovascular disease in psoriasis was provided by Elnabawi et al (89). In this prospective observational study, 121 patients without prior systemic therapy received treatment with various biologicals for 1 year; 169 patients with topical and/or phototherapy served as controls.…”

Section: Cardiovascular Inflammation In Psoriasis Experimental and CLmentioning

confidence: 89%

“…Other studies assessed the carotid plaque burden in psoriasis patients during biologic treatment (88,89). Interestingly, psoriasis patients receiving anti-TNF treatment exhibited decreased vascular inflammation and a gender-dependent effect on carotid plaque progression after 1 year (88).…”

Section: Cardiovascular Inflammation In Psoriasis Experimental and CLmentioning

confidence: 99%

IL-17A in Psoriasis and Beyond: Cardiovascular and Metabolic Implications

et al. 2020

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Interleukin 17A (IL-17A) is one of the currently known six members of the IL-17 cytokine family and is implicated in immune responses to infectious pathogens and in the pathogenesis of inflammatory autoimmune diseases like psoriasis. Psoriatic skin is characterized by high expression of IL-17A and IL-17F, which act on immune and non-immune cell types and strongly contribute to tissue inflammation. In psoriatic lesions, IL-17A, IL-17E, and IL-17F are involved in neutrophil accumulation, followed by the formation of epidermal micro abscesses. IL-17A together with other Th17 cytokines also upregulates the production of several chemokines that are implicated in psoriasis pathogenesis. IL17A-targeting antibodies show an impressive clinical efficacy in patients with psoriasis. Studies have reported an improvement of at least 75% as measured by the psoriasis area and severity index (PASI) in >80% of patients treated with anti-IL-17A therapy. Psoriasis skin manifestations, cardiovascular as well as metabolic disease in psoriasis appear to share pathogenic mechanisms evolving around IL-17A and its proinflammatory role. Thus, anti-IL-17A therapy not only improves skin manifestations of psoriasis, but also cardiovascular inflammation as well as metabolic factors and different domains of psoriatic arthritis (PsA) including peripheral arthritis, enthesitis, dactylitis, and axial involvement. This review summarizes the biological role of IL-17A, before reviewing currently available data on its role in the physiology and pathophysiology of the skin, as well as the cardiovascular and the metabolic system. In conclusion, clinical recommendations for patients with moderate to severe psoriasis based on the current available data are given.

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“…your Cardiovascular Research', we shared insights on how to publish high-impact science which was followed by talks discussing visibility for authors who publish in Cardiovascular Research, ethics in scientific publishing, as well as authors of top papers discussing their highly cited papers and most recent work. 42 We also encourage authors, including Young Investigator Award finalists, to submit their work to Cardiovascular Research, as we continue to remain dedicated to helping drive the development of the cardiovascular science community at the frontiers, as well as actively promoting and supporting young investigators. We anticipate and look forward to a fruitful FCVB conference in Budapest, 2021 and hope to see you all there.…”

mentioning

confidence: 99%