Abstract
Introduction: Psoriasis is a systemic inflammatory disease associated with increased cardiometabolic risk and coronary plaque burden. Epicardial adipose tissue volume (EATV) is considered a proinflammatory marker related to atherosclerotic plaque formation. The longitudinal impact of EATV on plaque characteristics, such as fibrofatty burden (FFB), assessed by coronary computed tomography angiography (CCTA), in psoriasis has not been reported. Hypothesis: 1) Psoriasis patients with increased EATV have a worse cardiometabolic profile and increased FFB. 2) Increasing EATV associates with increased FFB over four years. Methods: FFB by CCTA was assessed in three-hundred nineteen participants with psoriasis at baseline and one-hundred twenty-five at four years. A previously published automated framework for segmentation of the heart was used to generate EATV from non-contrast computed tomography scans and results were manually reviewed. Coronary characteristics were quantified using QAngio software. Results: Quartile analysis of EATV at baseline revealed a stepwise increase in hypertension (P<0.001), waist to hip ratio (P<0.001), visceral adiposity (P<0.001), homeostatic model assessment for insulin resistance (P<0.001), glycoprotein A (P<0.001) psoriasis area severity index (P=0.005) and FFB (P<0.001) with increasing EATV (Table 1). EATV associated with FFB (β=0.251; P <0.001) in models adjusted for Framingham risk score and waist to hip ratio. Longitudinal analysis showed EATV associated with FFB over four years in models adjusted for Framingham risk score and waist to hip ratio in psoriasis (β=0.288; P =0.009). Conclusion: Our study supports that EATV correlates with a high cardiometabolic risk profile in psoriasis. Further, we show that as EATV increases, there is a heightened risk of rupture-prone fibrofatty plaque. Further studies are needed to elucidate the role of EATV in predicting cardiovascular disease risk associated with psoriasis.
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