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Reduction in coronary artery disease in psoriasis patients treated with biologic therapies

Treating psoriasis with biologic drugs that target the immune system can reduce early plaque buildup that clogs arteries, restricts blood flow, and leads to heart attacks and stroke. The association between psoriasis and occlusive cardiovascular events was noted originally nearly 50 years ago [1], and it is generally attributed to the heightened systematic inflammation present in psoriasis patients, which results in excess low-density lipoproteins lining the arteries. What was not yet known was whether modulating the inflammatory condition with immunotherapy would result in reduced risk of cardiovascular disease.

Dr Nehal Mehta (National Heart, Lung, and Blood Institute, NIH, USA) presented the just-published results of the first in-human evidence that treating psoriasis patients with biologic systemic therapies has positive consequences on cardiovascular outcomes [2]. This prospective, observational study of the NIH Psoriasis Atherosclerosis Cardiometabolic Initiative cohort included 290 psoriasis patients, 121 of whom suffered moderate-to-severe skin disease and qualified for the biologic therapy according to treatment guidelines. For a year, Mehta and colleagues followed the entire cohort, all of whom had low cardiovascular risk at baseline, and compared the patients on biological treatments to those who did not receive biologic therapy. High-risk coronary plaque phenotypes were measured by coronary computed tomography angiography. A blinded reader (blinded to patient demographics, visit, and treatment), quantified total coronary plaque burden, and plaque subcomponents (calcified and non-calcified) in the 3 main coronary vessels >2 mm.
Study results show that biologic therapy was associated with an 8% reduction in coronary artery plaque, while other changes in other cardiovascular risk factors such as cholesterol, glucose, and blood pressure were unchanged. ‚ÄúThe findings that intrigued us most were that coronary plaque sub-components changed over 1 year, including the necrotic core and non-calcified components, which are the culprits for most heart attacks,‚ÄĚ Mehta said. These findings highlight that using biologic therapies to reduce the underlying inflammatory disease in patients has benefits in secondary complications, such as coronary artery disease, in particular of rupture prone plaque. However, it should be noted that this data is observational at this point, necessitating the initiation of randomised, controlled trials.

1. McDonald CJ, Calabresi P. Occlusive vascular disease in psoriatic patients. N Engl J Med. 1973 Apr 26;288(17):912.
2. Elnabawiet al. Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study. Cardiovasc Res. 2019 Mar 15;115(4):721-728.

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