A Randomized Open-Label Clinical Trial of Lipid-Lowering Therapy in Psoriasis to Reduce Vascular Endothelial Inflammation

Abstract

In psoriasis, immune systemic activation and cardiometabolic abnormalities, including dyslipidemia, play a role in promoting impaired endothelial health and increased cardiovascular (CV) risk ( Greb et al., 2016 Greb J.E. Goldminz A.M. Elder J.T. Lebwohl M.G. Gladman D.D. Wu J.J. et al. Psoriasis. Nat Rev Dis Primers. 2016; 2: 16082 Crossref PubMed Scopus (427) Google Scholar ). Patients with psoriasis have elevated brachial vein endothelial proinflammatory transcript expression (impaired vascular endothelial health), with the degree of impairment directly correlated with skin activity and circulating biomarkers of systemic inflammation ( Garshick et al., 2019 Garshick M.S. Barrett T.J. Wechter T. Azarchi S. Scher J.U. Neimann A. et al. Inflammasome signaling and impaired vascular health in psoriasis. Arterioscler Thromb Vasc Biol. 2019; 39: 787-798 Crossref PubMed Scopus (34) Google Scholar ). In psoriasis, TNF and IL-17A synergism promote inflammasome (IL-1β) signaling and downstream IL-6 production (driver of CRP) ( Verma et al., 2021 Verma D. Fekri S.Z. Sigurdardottir G. Bivik Eding C. Sandin C. Enerbäck C. Enhanced inflammasome activity in patients with psoriasis promotes systemic inflammation. J Invest Dermatol. 2021; 141: 586-595.e5 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar ), which associates with vascular endothelial inflammatory transcript expression, suggesting a pathogenic (immune-mediated) mechanism of atherosclerosis development ( Garshick et al., 2019 Garshick M.S. Barrett T.J. Wechter T. Azarchi S. Scher J.U. Neimann A. et al. Inflammasome signaling and impaired vascular health in psoriasis. Arterioscler Thromb Vasc Biol. 2019; 39: 787-798 Crossref PubMed Scopus (34) Google Scholar ). Is It Prime Time for Statin Therapy in Psoriasis?Journal of Investigative DermatologyVol. 142Issue 6PreviewIt has been over a decade and a half since the first large-scale study of the accelerated risk of myocardial infarction in psoriasis (Gelfand et al., 2006). Since then, a broad range of scientific approaches has determined that psoriasis itself is associated with a higher-risk subclinical vascular disease (Naik et al., 2015), high-risk coronary plaque (Lerman et al., 2017), and major adverse cardiovascular (CV) events (Mehta et al., 2010) and mortality (Noe et al., 2018). Although these studies have established that the risk of CV disease (CVD) is independent of traditional CV risk factors, psoriasis also has complex interactions with metabolic disease. Full-Text PDF