Abstract 12607: Improvement in Skin Inflammation Associates With Improvement in Aortic Vascular Inflammation by 18-FDG PET/CT in Psoriasis

Abstract

Introduction: Inflammation is a risk factor for the initiation and progression of atherosclerosis. Psoriasis (PSO), a chronic inflammatory skin disease, is an emerging risk factor for cardiovascular (CV) disease. Indeed PSO severity is associated with increased vascular inflammation (VI) by 18-FDG PET/CT in vivo and with future CV risk. However, the longitudinal impact of changes in PSO severity on vascular disease is unknown. Hypothesis: We hypothesized that an improvement in PSO severity would associate with an improvement in VI by FDG PET/CT. Methods: Consecutively recruited PSO patients (N=102) underwent FDG PET/CT scans, and cardiometabolic profiling at baseline and 1-year. VI was assessed as target-to-background ratio (TBR) (Excellence Brilliant Workstation). PSO severity was measured as Psoriasis Area Severity Index (PASI) score. The longitudinal change in VI of the aortic arch was analyzed using unadjusted and adjusted multivariable regression. Results: The cohort was middle-aged, had a low CV risk by Framingham risk score and had mild to moderate PSO severity. At follow-up, patients had a median improvement in PASI score of 31.91% (p<0.001) with use of topical (67%), biological (62%) and UVB (16%) therapy. Aortic TBR in these patients improved (6.3%, p<0.001) (Table 1). Improvement in PASI score associated with an improvement in aortic arch TBR beyond adjustment for traditional CV risk factors, statin use, & systemic/biologic PSO therapy (β=0.21, p = 0.03). Conclusions: Improvement in PSO severity associated with an improvement in aortic VI by FDG PET/CT, suggesting that skin inflammation may present a modifiable risk factor to mitigate CV risk. This finding of a 6.3% decrease in VI with improvement in PASI score is of similar magnitude to that observed after low-dose statin therapy in coronary artery disease, suggesting control of remote inflammation may quell vascular disease progression. Larger studies are needed to confirm these findings.