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Coronary microvascular dysfunction in patients with psoriasis

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Psoriasis is a common chronic inflammatory skin disorder that is associated with excess cardiovascular risk. Inflammation is a key mediator in the onset and progression of these cardiometabolic abnormalities; however, the excess cardiovascular risk conferred by psoriatic disease remains understudied. We investigated the prevalence and severity of CMD in patients with psoriasis and determined whether CMD is a result of CV risk factors and atherosclerotic burden.

Methods

This was a consecutive retrospective cohort study of patients with psoriasis, normal myocardial perfusion, and LV ejection fraction (EF) > 50% (N = 62) and matched controls without psoriasis (N = 112). Myocardial perfusion and myocardial flow reserve (MFR) were quantified using PET imaging. Atherosclerotic burden was determined by semi-quantitative computed tomography (CT) coronary calcium assessment.

Results

The prevalence of CMD (defined as MFR < 2) was 61.3% in patients with psoriatic disease, compared to 38.4% in a matched control population (P = .004). Furthermore, patients with psoriasis had a more severe reduction in adjusted MFR (2.3 ± .81 vs 1.92 ± .65, respectively, P = .001). The degree of atherosclerotic burden, as assessed by qualitative calcium score, was similar between psoriasis and controls.

Conclusions

Patients with psoriasis without overt CAD demonstrated a high prevalence of coronary vasomotor abnormalities that are not entirely accounted for by the commonly associated coronary risk factors or the burden of atherosclerosis.

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References

  1. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296:1735.

    Article  CAS  Google Scholar 

  2. Gelfand JM, Troxel AB, Lewis JD, et al. The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol. 2007;143:1493-9.

    PubMed  Google Scholar 

  3. Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J. 2010;31:1000-6.

    Article  Google Scholar 

  4. Mehta NN, Yu Y, Pinnelas R, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med. 2011;124:775.e1-6.

    Article  Google Scholar 

  5. Abuabara K, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the United Kingdom. Br J Dermatol. 2010;163:586-92.

    Article  CAS  Google Scholar 

  6. Khalid U, Ahlehoff O, Gislason GH, et al. Psoriasis and risk of heart failure: a nationwide cohort study. Eur J Heart Fail. 2014;16:743-8.

    Article  Google Scholar 

  7. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-6.

    Article  Google Scholar 

  8. Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(251-265):e19.

    Google Scholar 

  9. Gupta A, Taqueti VR, van de Hoef TP, et al. Integrated non-invasive physiological assessment of coronary circulatory function and impact on cardiovascular mortality in patients with stable coronary artery disease. Circulation. 2017;136:2325-36.

    Article  Google Scholar 

  10. Murthy VL, Naya M, Foster CR, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011;124:2215-24.

    Article  Google Scholar 

  11. Osborne MT, Bajaj NS, Taqueti VR, et al. Coronary microvascular dysfunction identifies patients at high risk of adverse events across cardiometabolic diseases. J Am Coll Cardiol. 2017;70:2835-7.

    Article  Google Scholar 

  12. Taqueti VR, Hachamovitch R, Murthy VL, et al. Global coronary flow reserve associates with adverse cardiovascular events independently of luminal angiographic severity, and modifies the effect of early revascularization. Circulation. 2015;131:19-27.

    Article  Google Scholar 

  13. Piaserico S, Osto E, Famoso G, et al. Long-term prognostic value of coronary flow reserve in psoriasis patients. Atherosclerosis. 2019;289:57-63.

    Article  CAS  Google Scholar 

  14. El Fakhri G, Kardan A, Sitek A, et al. Reproducibility and accuracy of quantitative myocardial blood flow assessment with (82)Rb PET: comparison with (13)N-ammonia PET. J Nucl Med Off Publ Soc Nucl Med. 2009;50:1062-71.

    Google Scholar 

  15. Lortie M, Beanlands RSB, Yoshinaga K, Klein R, Dasilva JN, DeKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging. 2007;34:1765-74.

    Article  Google Scholar 

  16. Camici PG, d’Amati G, Rimoldi O. Coronary microvascular dysfunction: mechanisms and functional assessment. Nat Rev Cardiol. 2015;12:48-62.

    Article  Google Scholar 

  17. Einstein AJ, Johnson LL, Bokhari S, et al. Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET/CT and SPECT/CT with standard agatston score. J Am Coll Cardiol. 2010;56:1914-21.

    Article  Google Scholar 

  18. Chiles C, Duan F, Gladish GW, et al. Association of coronary artery calcification and mortality in the national lung screening trial: a comparison of three scoring methods. Radiology. 2015;276:82-90.

    Article  Google Scholar 

  19. Azfar RS, Seminara NM, Shin DB, Troxel AB, Margolis DJ, Gelfand JM. Increased risk of diabetes and likelihood of receiving diabetes treatment in patients with psoriasis. Arch Dermatol. 2012;148:995-1000.

    Article  Google Scholar 

  20. Ma L, Li M, Wang H, Li Y, Bai B. High prevalence of cardiovascular risk factors in patients with moderate or severe psoriasis in northern China. Arch Dermatol Res. 2014;306:247-51.

    Article  CAS  Google Scholar 

  21. Joshi AA, Lerman JB, Dey AK, et al. Association between aortic vascular inflammation and coronary artery plaque characteristics in psoriasis. JAMA Cardiol. 2018;3:949-56.

    Article  Google Scholar 

  22. Dey AK, Joshi AA, Chaturvedi A, et al. Association between skin and aortic vascular inflammation in patients with psoriasis: a case-cohort study using positron emission tomography/computed tomography. JAMA Cardiol. 2017;2:1013-8.

    Article  Google Scholar 

  23. Lockshin B, Balagula Y, Merola JF. Interleukin 17, inflammation, and cardiovascular risk in patients with psoriasis. J Am Acad Dermatol. 2018;79:345-52.

    Article  CAS  Google Scholar 

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Disclosures

Dr. Dorbala is a member of an advisory board for General Electric Health Care and has received consulting fees from Pfizer. Dr. Di Carli has received consulting fees from Bayer and Janssen. Dr. Blankstein has received consulting fees from Amgen. Dr. Merola is a consultant and/or investigator for Merck, Abbvie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and Leo Pharma. Weber, Perez-Chada, Divakaran, Brown, Taqueti, and Liao have no disclosures to report.

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Authors and Affiliations

  1. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, USA

    Brittany Weber MD, PhD, Sanjay Divakaran MD, Jenifer M. Brown MD, Viviany Taqueti MD, MPH, Sharmila Dorbala MD, MPH, Ron Blankstein MD & Marcelo Di Carli MD

  2. Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Boston, USA

    Katherine Liao MD, MPH

  3. Department of Dermatology, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis St, ASB-L1 037C, Boston, MA, 02115, USA

    Lourdes M. Perez-Chada MD, MMSc & Joseph F. Merola MD, MMSc

Authors
  1. Brittany Weber MD, PhD
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  2. Lourdes M. Perez-Chada MD, MMSc
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  3. Sanjay Divakaran MD
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  4. Jenifer M. Brown MD
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  5. Viviany Taqueti MD, MPH
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  6. Sharmila Dorbala MD, MPH
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  7. Ron Blankstein MD
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  8. Katherine Liao MD, MPH
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  9. Joseph F. Merola MD, MMSc
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  10. Marcelo Di Carli MD
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Corresponding author

Correspondence to Marcelo Di Carli MD.

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Weber, B., Perez-Chada, L.M., Divakaran, S. et al. Coronary microvascular dysfunction in patients with psoriasis. J. Nucl. Cardiol. 29, 37–42 (2022). https://doi.org/10.1007/s12350-020-02166-5

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  • DOI: https://doi.org/10.1007/s12350-020-02166-5

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