- Psoriasis therapy can significantly reduce coronary inflammation
- The progression of therapy can be measured by perivascular fat attenuation index (FAI) – a novel imaging biomarker
- Psoriasis therapy lowers the risk of cardiac events such as heart attack and stroke
is linked to a reduction in coronary inflammation, reveals a new study from the
Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD, USA.
The research team found that biologic therapy using anti-inflammatory drugs for treating moderate to severe psoriasis can significantly reduce coronary inflammation in patients suffering from this skin disorder.
The study used a novel imaging biomarker called perivascular fat attenuation index (FAI), which measured the effect of biologic therapy on reduction of coronary inflammation. In fact, this is the first study using FAI to measure the effect of biologic therapy on coronary inflammation.
Psoriasis and its Impact on Coronary InflammationPsoriasis is a chronic skin condition that occurs due to a build-up of skin cells, which leads to the formation of dry, scaly, inflamed, and itchy patches on the skin. Psoriasis affects approximately 3-5 percent of people in the US, and is associated with widespread systemic inflammation, which increases the risk of vascular diseases.
Inflammation is often associated with immune responses targeted against infectious pathogens. But the immune response can also attack the blood vessels, increasing chances of blood clot formation, causing arterial blockage and eventually leading to heart attack and stroke. Approximately 20-30 percent of the US population is at risk of these types of cardiovascular events, arising from inflammation.
Study TeamThe study was led by Dr. Nehal N. Mehta, MD, MSCE, FAHA, who is a Lasker Clinical Research Scholar and Head of the Laboratory of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute (NHLBI), a constituent institute of the National Institutes of Health (NIH), Bethesda, MD, USA.
The co-author of the paper was Dr. Charalambos Antoniades, MD, PhD, who is a Professor of Cardiovascular Medicine and Deputy Head of the Division of Cardiovascular Medicine at the Radcliffe Department of Medicine, Medical Sciences Division, University of Oxford, UK. He is also a Senior Clinical Fellow of the British Heart Foundation.
Salient Features of the Study
- 134 patients with moderate to severe psoriasis were included in the study
- None of the patients received biologic therapy for 3 months prior to the study
- 82 patients received biologic therapy (Intervention Group)
- 52 patients didn't receive biologic therapy (Control Group)
- The patients were recruited from the Psoriasis Atherosclerosis Cardiometabolic Initiative cohort of NIH
- All patients underwent computed tomography (CT) scans at the start of the study and after one year
- Coronary inflammation was assessed using the perivascular fat attenuation index (FAI)
- Significant reduction in coronary inflammation was observed in the Intervention Group
- Coronary inflammation was also reduced in patients with pre-existing coronary artery plaques following biologic therapy
- There was no change in the Control Group
Fat Attenuation Index (FAI) and its Prediction of Future Cardiovascular EventsCoronary inflammation inhibits the deposition of perivascular fat (fat around the arteries). This results in attenuation (reduction) of the fatty layer around the coronary arteries. FAI is a novel imaging biomarker that is capable of capturing coronary inflammation by spatial mapping changes in perivascular fat attenuation on coronary CT angiography (CTA). The present study used FAI to measure the effect of biologic therapy on coronary inflammation.
Importantly, FAI has a very high predictive power and is capable of predicting a person's risk of life-threatening cardiovascular events, years ahead of conventional biomarkers.
"FAI is a new method of analyzing CT scans that can predict a patient's risk of fatal heart attacks and other cardiac events years in advance, and independent of other traditional risk factors for heart disease," explains Antoniades. "In fact, our research has found that an abnormal perivascular FAI was linked to a six- to nine-fold increased risk of major adverse cardiovascular events."
Implications of the StudyThe present study has wide-ranging implications. The research findings are not only applicable for psoriasis, but also other chronic inflammatory diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis. Importantly, it is well-established that these diseases increase the risk of heart attacks and strokes.
Concluding RemarksThe research team is highly optimistic that the high predictive power of FAI will greatly facilitate in planning treatment well in advance. This could bring about a revolutionary change, which will promote personalized medicine in cardiac care.
"Coronary inflammation offers important clues about the risk of developing heart artery disease," says Mehta. "Our findings add to the growing body of research that shows treating underlying inflammatory conditions may reduce the risk of cardiovascular diseases."
Funding SourceThe study was funded by the NIH's National Heart, Lung, and Blood Institute (NHLBI), Bethesda, MD, USA.
- Psoriasis therapy linked to reduced coronary inflammation in patients with the skin condition - (https://www.nhlbi.nih.gov/news/2019/psoriasis-therapy-linked-reduced-coronary-inflammation-patients-skin-condition)