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Psoriasis, Vascular Inflammation, and CV Events

J Am Acad Dermatol; ePub 2017 Aug 18; Egeberg, et al

In a recent study, researchers found detrimental effects of psoriasis duration on vascular inflammation and a major cardiovascular event (MACE), suggesting that cumulative duration of exposure to low-grade chronic inflammation may accelerate vascular disease development and MACEs. Researchers utilized 2 resources to understand the effect of psoriasis duration on vascular disease and CV events: (1) a human imaging study and (2) a population-based study of CVD events. First, patients with psoriasis (n=190) underwent fludeoxyglucose F 18 positron emission tomography/computed tomography (duration effect reported as a β-coefficient). Second, MACE risk was examined by using nationwide registries (adjusted hazard ratios in patients with psoriasis [n=87,161] vs the general population [n=4,234,793]). They found:

  • In the human imaging study, patients were young, of low CV risk by traditional risk scores, and had a high prevalence of cardiometabolic diseases.
  • Vascular inflammation by fludeoxyglucose F 18 positron emission tomography/computed tomography was significantly associated with disease duration (β = 0.171).
  • In the population-based study, psoriasis duration had strong relationship with MACE risk (1.0% per additional year of psoriasis duration).

Citation:

Egeberg A, Skov L, Joshi AA, et al. The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events. [Published online ahead of print August 18, 2017]. J Am Acad Dermatol. doi:10.1016/j.jaad.2017.06.028.

Commentary:

This article provides further evidence of a correlation between vascular inflammation and the risk of major adverse cardiovascular events and the duration of psoriasis. By utilizing a PET scan imaging study, the authors have demonstrated a detrimental effect of psoriasis duration on cardiovascular disease beyond traditional cardiovascular risk factors, even in patients with low cardiovascular risk scores. Providers should consider inquiring about duration of psoriasis when assessing cardiovascular risk factors. While, one limitation in the population study was a lack of information for BMI and levels of physical exercise, other data showed that adjustment for BMI did not significantly change the relationship between duration of disease and vascular inflammation. —Paul S. Yamauchi, MD, PhD

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