Biologic treatment of psoriasis could lead to significant reduction in heart disease

Psoriasis patients treated with biologic therapy, which are protein infusions to suppress inflammation, had a significant reduction in high-risk plaque in the heart arteries, over one year, new research shows today in Circulation: cardiovascular imaging, a journal of the American Heart Association.

Chronic inflammation in people with psoriasis is associated with a higher risk of developing coronary artery disease. Biological therapy drugs are proteins that are given by injection or infusion and suppress the process of inflammation by blocking the action of cytokines, which are proteins that promote systemic inflammation.

Previous research has shown a clear link between psoriasis and the development of high-risk coronary plaque. This study characterizes a necrotic nucleus rich in lipids, a dangerous type of coronary plaque made up of dead cells and cellular debris that can rupture. A ruptured plaque can lead to a heart attack or stroke.

“Having an inflamed plaque that is susceptible to rupture increases the risk of heart attack fivefold in ten years,” said Nehal N. Mehta, MD, MSCE, FAHA, lead author of the study, lead investigator at Lasker and head of the inflammation lab. and cardio-metabolic disease at the National Heart, Lung, and Blood Institute of the National Institutes of Health in Bethesda, Maryland.

This is the first time that an imaging study in humans has shown what a year of continuous, untreated inflammation can do to the arteries in the heart and that we can reverse that damage. Untreated inflammation is dangerous. You’re just waiting for a heart attack or a stroke. “

Nehal N. Mehta, MD, MSCE, FAHA, lead study author and Lasker lead investigator and head of the Inflammation and Cardiometabolic Disease Lab, National Heart, Lung, and Blood Institute, National Institutes of Health

The analysis involved 209 middle-aged patients (aged 37 to 62) with psoriasis who participated in the Cardiometabolic Psoriasis Atherosclerosis Initiative at the National Institutes of Health, an ongoing observational study. Of these participants, 124 received biological therapy and 85 were in the control group, treated only with topical creams and light therapy.

To measure the effects of biologic therapy on the arteries of the heart, the researchers performed cardiac computed tomography (CT) scans on all study participants before starting treatment and a year later. The CT results between the two groups were then compared.

At the start of the study, participants with psoriasis had a low cardiovascular risk based on conventional cardiovascular risk scores, and severe psoriasis was associated with a higher body mass index (BMI), a high C-reactive protein. tenderness (a measure of systemic inflammation) and higher levels of coronary artery plaque.

After one year of treatment, patients who received biological treatment were compared with the control group. The researchers found:

Biologic treatment was associated with an 8% reduction in coronary plaque. In contrast, those in the control group experienced a slightly increased progression of coronary plaque.

Even after adjusting for cardiovascular risk factors and the severity of psoriasis, patients treated with biologic therapy had a reduction in coronary plaque.

“There is an approximately 6-8% reduction in coronary plaque after treatment with statins. Likewise, our biologic therapy treatment reduced coronary plaque by the same amount after one year. These results suggest that biologic therapy for treating psoriasis may be just as beneficial as statin therapy on cardiac arteries, ”Mehta said.

This study has implications for people with psoriasis and possibly for people with other chronic inflammatory conditions such as HIV, lupus, and rheumatoid arthritis, who are also at increased risk for heart disease.

“We have never been able to show healing from an inflamed plaque like this in humans. Biological therapy reduces systemic inflammation and immune activation, and it has a favorable impact on improvement. of overall vascular health, ”Mehta said. “Imagine if we can treat both psoriasis and coronary heart disease with just one therapy – that’s the question to ask in future studies.”

The study results should be interpreted with caution as they were limited by a short follow-up period and a relatively small number of patients. Larger randomized controlled studies are needed to better understand how changes in coronary plaque can lead to reduced heart attacks and strokes in people with psoriasis.


Journal reference:

Choi, H., et al. (2020) Treatment of Psoriasis with Biological Therapy is Associated with Improving the Lipid-Rich Necrotic Core of Coronary Plaque. Circulation: cardiovascular imaging.



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