Coronary Plaque Characterization in Psoriasis.

Abstract

Article, see p 263 Psoriasis is a chronic immune-mediated disease that affects both the skin and joints in 30% to 35% of patients.1 Clinically, it is characterized by well-demarcated, erythematous plaques covered by silvery-white scales, traditionally affecting the elbows, knees, and scalp. However, it frequently presents in multiple anatomic locations, including body folds and genitals.2 It affects ≈2% of the population worldwide.3 The process of atherosclerosis is now also considered an inflammatory disorder with multiple proinflammatory cytokines shared with psoriasis (Figure).4 Figure. Psoriasis vs atherosclerosis: common inflammatory pathways. IFN-γ indicates interferon-γ; IL, interleukin; Th, T helper; TNF-α, tumor necrosis factor-α; Treg, regulatory T; and WBC, white blood cell. Psoriasis is strongly associated with multiple comorbidities, including obesity, tobacco smoking, diabetes mellitus, dyslipidemia, hypertension, and psychiatric, autoimmune, renal, and cardiovascular diseases, among others.5 Multiple publications have confirmed the association between psoriasis and vascular disease.5–8 Patients with psoriasis, especially those <50 years old and with more severe disease, are at higher risk of developing coronary artery disease (CAD).9 Furthermore, patients with moderate to severe psoriasis have a reduced life expectancy of ≈4 to 5 years relating to cardiovascular disease (CVD). Traditional risk assessment tools such as the Framingham risk score do not appropriately estimate this CAD risk. Recent studies that used both noninvasive and invasive coronary artery studies of patients with psoriasis and have shown a higher prevalence of CAD in patients with psoriasis compared with healthy individuals.10–13 Our recent coronary artery calcium score study of 129 patients with psoriasis with moderate to severe disease revealed a risk similar to that of patients with type II diabetes mellitus and significantly higher than that of healthy patients.10 One of the …