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. 2017 Oct;77(4):650-656.e3.
doi: 10.1016/j.jaad.2017.06.028. Epub 2017 Aug 18.

The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events

Alexander Egeberg  1 , Lone Skov  2 , Aditya A Joshi  3 , Lotus Mallbris  4 , Gunnar H Gislason  5 , Jashin J Wu  6 , Justin Rodante  3 , Joseph B Lerman  3 , Mark A Ahlman  3 , Joel M Gelfand  7 , Nehal N Mehta  8
Affiliations

The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events

Alexander Egeberg et al. J Am Acad Dermatol. 2017 Oct.

Abstract

Background: Psoriasis is associated with risk of cardiovascular (CV) disease (CVD) and a major adverse CV event (MACE). Whether psoriasis duration affects risk of vascular inflammation and MACEs has not been well characterized.

Objectives: We utilized two 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.

Methods: 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) versus the general population (n = 4,234,793).

Results: 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, P = .002). In the population-based study, psoriasis duration had strong relationship with MACE risk (1.0% per additional year of psoriasis duration [hazard ratio, 1.010; 95% confidence interval, 1.007-1.013]).

Limitations: These studies utilized observational data.

Conclusion: We found detrimental effects of psoriasis duration on vascular inflammation and MACE, suggesting that cumulative duration of exposure to low-grade chronic inflammation may accelerate vascular disease development and MACEs. Providers should consider inquiring about duration of disease to counsel for heightened CVD risk in psoriasis.

Keywords: 18-FDG PET/CT; cardiovascular disease; inflammation; psoriasis.

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Conflict of interest statement

Disclosures/Conflicts of interest

Dr. Egeberg has received research funding from Pfizer and Eli Lilly, and honoraria as consultant and/or speaker from Pfizer, Eli Lilly, Novartis, Galderma, and Janssen Pharmaceuticals. Dr. Skov has been a paid speaker for Pfizer, AbbVie, Eli Lilly, Novartis and LEO Pharma, and has been a consultant or served on Advisory Boards with Pfizer, AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma and Sanofi. She has served as an investigator for Pfizer, AbbVie, Eli Lilly, Novartis, Amgen, Regeneron and LEO Pharma and received research and educational grants from Pfizer, AbbVie, Novartis, Sanofi, Janssen Cilag and Leo Pharma. Dr. Mallbris is currently employed by Eli Lilly. Dr. Gislason is supported by an unrestricted research scholarship from the Novo Nordisk Foundation and reports research grants from Pfizer, Bristol-Myers Squibb, AstraZeneca, Bayer and Boehringer Ingelheim. Dr. Wu received research funding from AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Coherus Biosciences, Dermira, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Regeneron, Sandoz, and Sun Pharmaceutical Industries; he is a consultant for AbbVie, Amgen, Celgene, Dermira, Eli Lilly, Pfizer, Regeneron, and Sun Pharmaceutical Industries. In the previous 12 months Dr. Gelfand served as a consultant for Coherus (DSMB), Dermira, Janssen Biologics, Merck (DSMB), Novartis Corp, Regeneron, Sanofi and Pfizer Inc., receiving honoraria; and receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis Corp, Regeneron, Sanofi, Celgene, and Pfizer Inc.; and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Abbvie. Dr. Gelfand is a co-patent holder of resiquimod for treatment of cutaneous T cell lymphoma. Dr. Mehta is a full-time United States government employee.

Figures

Figure 1
Figure 1. Nelson-Aalen cumulative hazards graph of the population cohort
MACE risk in patients with psoriasis stratified based on disease duration less (n=57,941) or more (n=29,220) than 10 years, compared with the general population (n=4,234,793)
Figure 2
Figure 2. Association between vascular inflammation and psoriasis disease duration in the NIH cohort
Unadjusted and fully adjusted regression plots demonstrate a direct association between psoriasis disease duration and vascular inflammation in the NIH cohort beyond traditional cardiovascular risk factors.
See this image and copyright information in PMC

References

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