Biologic therapy for psoriasis may reduce heart disease

Date:
September 15, 2020
Source:
American Heart Association
Summary:
Biologic therapy for psoriasis - protein-based infusions to suppress
inflammation - was associated with a significant reduction in
high-risk plaque in heart arteries, over one-year, according to new
research. The positive association between biologic therapy and a
decrease in high-risk plaque in heart arteries was significant after
adjusting for cardiovascular risk factors and psoriasis severity.



FULL STORY ========================================================================== Patients with psoriasis treated with biologic therapy, which are
protein-based infusions to suppress inflammation, had a significant
reduction in high-risk plaque in heart arteries, over one-year, according
to new research published today in Circulation: Cardiovascular Imaging,
an American Heart Association journal.


========================================================================== Chronic inflammation in people with psoriasis is associated with a
higher risk of developing coronary artery disease. Biologic therapy
medications are proteins that are given by injection or infusion and
suppress the inflammation process 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 provides characterization of a lipid- rich necrotic core, a dangerous type of
coronary plaque made up of dead cells and cell debris that is prone to
rupture. Ruptured plaque can lead to a heart attack or stroke.

"Having inflamed plaque that is prone to rupture increases the risk of
heart attack five-fold within ten years," said Nehal N. Mehta, M.D.,
M.S.C.E., FAHA, study senior author, a Lasker Senior Investigator and
chief of the Lab of Inflammation and Cardiometabolic Diseases at the
National Heart, Lung, and Blood Institute at the National Institutes of
Health in Bethesda, Maryland.

"This is the first time an imaging study in humans has shown what one year
of ongoing, untreated inflammation can do to arteries of the heart and
that we can reverse this damage. Untreated inflammation is dangerous. You
are just waiting for a heart attack or stroke to happen," Mehta said.

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



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

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

After one year of treatment, patients who received biologic therapy
were compared to the control group. Researchers found: Biologic therapy
was associated with an 8% reduction in coronary plaque. In contrast,
those in the control group experienced slightly increased coronary
plaque progression.

Even after adjusting for cardiovascular risk factors and psoriasis
severity, patients treated with biologic therapy had reduced coronary
plaque.

"There is approximately 6-8% reduction in coronary plaque following
therapy with statins. Similarly, our treatment with biologic therapy
reduced coronary plaque by the same amount after one year. These findings suggest that biologic therapy to treat psoriasis may be just as beneficial
as statin therapy on heart 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 also have increased risk of heart disease.

"We have never before been able to show healing of an inflamed plaque
like this in humans. Biologic therapy reduces systemic inflammation and
immune activation, and it has a favorable impact on improving overall
vascular health," Mehta said. "Imagine if we can treat both psoriasis
and coronary heart disease with one therapy -- that is the question to
be asked in future studies." The study's findings should be interpreted
with caution because it was 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 may lead
to a reduction in heart attacks and strokes in people with psoriasis.


========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Harry Choi, Domingo E. Uceda, Amit K. Dey, Khaled M. Abdelrahman,
Milena
Aksentijevich, Justin A. Rodante, Youssef A. Elnabawi, Aarthi Reddy,
Andrew Keel, Julie Erb-Alvarez, Heather Teague, Martin P. Playford,
Wunan Zhou, Marcus Y. Chen, Joel M. Gelfand, David A. Bluemke,
Andrew Buckler, Nehal N. Mehta. Treatment of Psoriasis With Biologic
Therapy Is Associated With Improvement of Coronary Artery Plaque
Lipid-Rich Necrotic Core. Circulation: Cardiovascular Imaging,
2020; 13 (9) DOI: 10.1161/ CIRCIMAGING.120.011199 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200915090119.htm

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