A study examining the effect of psoriasis treatment on high-risk coronary plaque characteristics presented Tuesday revealed additional evidence that remote inflammation can modulate coronary disease.
The architect and senior author of the study, Nehal N. Mehta, MD, MSCE, FAHA, said in an interview before the meeting that the results of the study are a warning to physicians not to ignore ongoing, low-grade sources of inflammation in patients.
“We know psoriasis is a common, chronic inflammatory skin disease, and we know inflammation is critical to atherosclerosis,” said Mehta, chief of inflammation and cardiometabolic diseases at the National Heart, Lung, and Blood Institute. “This needs to be taken seriously. We recently showed that patients whose skin disease got worse over time had worsening of high-risk coronary plaque. If we follow the people with high-risk plaques for the next decade, we will see a number of preventable heart attacks.”
The study results were presented in an abstract poster session by Jonathan Chung, MD, a fourth-year medical student at SUNY Downstate College of Medicine in New York. Chung worked on the study with Mehta while doing a research year at the National Institutes of Health through the NIH Medical Research Scholars Program.
For the study, Mehta’s team used coronary CT angiography to measure the amount of high-risk plaque in patients with psoriasis. Participants were measured at baseline and again one year later. The study showed that when the skin condition improves, patients have a decrease in high-risk plaque features. A similar investigation by Mehta has shown the converse to also be true. That study, presented earlier this year, showed that when patients with psoriasis were not effectively treated, their high-risk coronary plaque features increased.
“When the inflammation goes down as assessed by their psoriasis skin disease severity, the high-risk coronary plaque features go down,” Mehta said. “These findings add to the body of literature that uncontrolled inflammation is a dangerous thing, not only for systemic inflammation, but the blood vessels as well.”
The study’s cohort included 72 middle-age patients with moderate to severe psoriasis at baseline. Participants who improved their skin disease had a 68 percent decrease in their high-risk plaque score. Conversely, those who worsened had a 50 percent increase in their high-risk plaque score. Larger studies will need to be conducted to confirm these findings.
“Our findings echo recent data from the CANTOS trial, which examined whether treatment of residual inflammation in patients with prior heart attack reduced recurrent heart attack,” Mehta said.