New study shows that common therapy options for psoriasis (PSO)-a chronic inflammatory skin disease-can help reduce coronary plaque.
According to a study conducted by the Society for Cardiovascular Angiography and Interventions, not only do the psoriasis treatments reduce the volume of the plaque, but also the plaque becomes less inflammatory over time harbouring fewer characteristics prone to rupture and cause a heart attack.
Coronary heart disease (CHD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.
It is the first-in-human observational study demonstrating that treating remote inflammation in the body can modulate coronary disease.
Psoriasis is associated with an accelerated risk of myocardial infarction and has increased risk for atherogenesis, which is the development of plaque within the walls of blood vessels.
For the first time, recent evidence demonstrated a significant reduction in adverse cardiovascular events targeting interleukin-1 beta (IL1B), a cytokine that is central to the inflammatory response.
The authors worked to identify if treatment of the inflammatory skin disease potentially affected coronary plaque. Anti-tumor necrosis factor (TNF) agents are commonly used, biologic, and FDA-approved immunomodulatory treatment options for PSO.
More than 80 consecutive patients were stratified by biologic treatment (predominantly anti-TNF; n=57) and non-biologic treatment (n= 27). Non-calcified burden (NCB), plaque volume (PV), and maximal artery stenosis in the proximal vessels (diameter>2mm) were blindly assessed based on coronary CT angiography using dedicated software.
The patients were middle-aged and at low cardiovascular risk by traditional risk scores. At one-year, the plaque volume in the biologically treated group decreased by 40 percent (p=0.002), a finding not observed in those without treatment (p=0.04).
Trends in NCB and maximal stenosis were significant and consistent with PV in both groups. Furthermore, change in PV was also positively associated with a change in IL1B (ß=0.56, p=0.03), even after adjustment for traditional cardiovascular risk factors and statin use.
“To see a reduction in coronary plaque after just one year of biologic therapy alone is incredible and very assuring. It’s the first time we’re seeing treatment of a skin disease with biologic therapy have an impact specifically on the plaque in the coronary,” said Nehal N. Mehta, the Principal Investigator of the study.
“Our study results further emphasize the importance of patients maintaining and treating psoriasis to decrease the risks of adverse cardiovascular events occurring. This also opens the door for us to look at other disease states and see how anti-inflammatory therapy options could impact coronary plaque over time.”
The study findings appear in the journal Catheterization and Cardiovascular Interventions.