Chronic Inflammation From Psoriasis Accelerates Cardiovascular Disease - EMJ

Chronic Inflammation from Psoriasis Found to Accelerate Cardiovascular Disease

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RESEARCH presented at the American Society for Preventive Cardiology (ASPC) Congress on Cardiovascular Disease (CVD) Prevention, which took place in Louisville, Kentucky, USA, from 29th–31st July, 2022, has shown that the chronic inflammation attributed to moderate-to-severe psoriasis could accelerate the risks of CVD. Systemic psoriatic inflammation can be linked to the rupture of plaques that are seen in cases of myocardial infarction. Data has shown that adults with psoriasis are likely to experience adverse cardiovascular events around 10 years sooner than those without the condition. 

Nehal N. Mehta, Chief, Laboratory of Inflammation and Cardiometabolic Diseases and Lasker Senior Investigator, National Heart, Lung, and Blood Institute (NHLBI), Bethesda, Maryland, USA, noted how many studies have evidenced the link between inflammation and cardiometabolic disease, and that systemic inflammatory diseases can drive this disease progression even further. Mehta explained: “There are over 1 billion immune cells activated within the body during severe psoriatic flare,” highlighting the intrinsic link between CVD and atherosclerotic diseases. 

Several immune factors are present in both psoriasis and atherosclerosis, including keratinocytes and T cells, which activate myeloid dendritic cells and ultimately drive Th1 and Th17 cell responses to keratinocytes. Mehta explained further: “In the skin itself, all of these perpetuating molecules become very important for driving not only psoriatic skin disease but also atherosclerotic CVD.” Researchers from the National Institutes of Health (NIH) have conducted studies using patients with moderate-to-severe psoriasis as a human model, with participants providing blood and tissue samples and undergoing deep phenotyping. The results of this study were then compared to samples from patients with diabetes, coronary disease, and a BMI-matched group of healthy volunteers. Researchers observed a 20% increase in total plaque burden in patients with psoriasis. 

Another study conducted by Mehta and colleagues compared the changes in total plaque over the period of 1 year in 89 patients with moderate-to-severe psoriasis who opted for biologic treatment and 32 patients who chose no biologic therapy. Coronary CT angiography scans were taken at baseline, and 1 year later. Researchers observed that patients who opted for no biologic therapy had 33% higher systemic inflammation than those who underwent treatment. Those who underwent biologic therapy also presented with a decrease in coronary plaque. Mehta noted: “This is showing (that) 1 year of untreated inflammation is dangerous for the vasculature.” This study highlights the importance of sufficient treatment of chronic inflammation and the cardiovascular dangers associated with it being left untreated. 

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