Treatment of psoriasis related to a reduction of coronary inflammation in patients with a skin condition

Press release

Wednesday, July 31, 2019

A new imaging biomarker could track interventions on coronary artery disease.

The researchers found that anti-inflammatory biological therapies used to treat moderate to severe psoriasis can significantly reduce coronary inflammation in patients with chronic skin problems. Scientists said the results are particularly noteworthy because of the use of a new imaging biomarker, perivascular fat attenuation index (IAF), able to to measure the effect of therapy on the reduction of inflammation.

The study published online in JAMA cardiology, has implications not only for people with psoriasis, but also for those with other chronic inflammatory diseases, such as lupus and rheumatoid arthritis. These conditions are known to increase the risk of heart attacks and strokes. The study was funded by the National Institute of Heart, Lung and Blood (NHLBI), part of the National Institutes of Health,

"Coronary artery inflammation provides important clues to the risk of developing cardiac arterial disease," said Nehal N. Mehta, MD, lead author of the study, cardiologist and head of the NHLBI's Inflammatory and Cardiometabolic Disease Laboratory. "Our findings add to the growing body of research that shows that treating underlying inflammatory conditions can reduce the risk of cardiovascular disease."

The researchers badyzed 134 patients with moderate-to-severe psoriasis who had not received biologic therapy for at least three months before starting treatment in the study. Fifty-two of these patients who chose not to receive the biological treatment were treated with topical or light therapies only and served as a control group. Participants come from an ongoing prospective cohort study, the cardiometabolic initiative cohort for the treatment of psoriasis and atherosclerosis at the NIH.

The inflammation of the coronary arteries particularly affects the perivascular fat – adipose tissue surrounding the arteries – by altering its composition, thus making it less or less oily, as indicated by the index of impairment perivascular fat (IAF), which researchers in this study used to measure effects. biological products on the coronary inflammation.

"FAI is a new method of computed tomography badysis that can predict the risk of fatal heart attacks and other cardiac events in a patient years in advance, regardless of other traditional risk factors. of heart disease, "said Charalambos Antoniades, co-author of the study. Professor of Cardiovascular Medicine at the University of Oxford. "In fact, our research has shown that an abnormal perivascular FAI was linked to a six to nine times higher risk of major adverse cardiovascular events."

The 134 patients, all of whom had low cardiovascular risk, underwent a CT scan at the start of the study and again one year later to badess coronary inflammation with the help of the I / Os. Perivascular IAF. The researchers found a significant reduction in coronary artery inflammation in those receiving biological therapy, but there was no change in the control group. Even patients with preexisting coronary artery plaque have found a reduction in coronary inflammation after biological treatment.

"After finding the predictive value of perivascular IAF for cardiac events, it remained to be determined if we could modify it with the help of anti-inflammatory interventions. To our knowledge, our study is the first to use this measure to evaluate the potential effects of biological therapy on coronary inflammation, "Mehta said.

The researchers believe that the strength of perivascular IAD in predicting the risk of future cardiac events could guide each patient's therapeutic decisions, favoring a more personalized approach to medicine.

Psoriasis, a common skin condition affecting 3 to 5% of the US population, is badociated with increased systemic inflammation, which increases the risk of blood vessel disease and diabetes. Inflammation occurs when the defensive mechanism of the body intervenes to ward off infections or diseases, but this mechanism can turn against itself if it is triggered, for example, by an excess of low-density lipoproteins ( LDL) which infiltrate into the walls of the arteries.

The resulting inflammatory response can increase the formation of blood clots, which block the arteries leading to heart attack and stroke. Inflammation exposes 20% to 30% of the American population to this type of event.

About National Heart, Lung and Blood Institute (NHLBI): NHLBI is the world leader in leading and supporting research on heart, lung and blood diseases and sleep disorders that advances scientific knowledge, improves public health and saves lives. For more information, visit https://www.nhlbi.nih.gov.

About the National Institutes of Health (NIH):
The NIH, the country's medical research agency, has 27 institutes and centers and is part of the US Department of Health and Human Services. NIH is the lead federal agency that leads and supports basic, clinical and translational medical research. She studies causes, treatments and cures for common and rare diseases. For more information on NIH and its programs, visit www.nih.gov.

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