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Anti-inflammatory psoriasis agents could reduce coronary artery plaque
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Anti-inflammatory biologic therapy for treatment of severe psoriasis reduced coronary artery plaque, raising questions about whether such agents could have a role in prevention of CHD, researchers reported in Cardiovascular Research.
“Classically a heart attack is caused by one of five risk factors: diabetes, hypertension, high cholesterol, family history or smoking,” Nehal N. Mehta, MD, chief of inflammation and cardiometabolic diseases at the NHLBI, said in a press release from the NIH. “Our study presents evidence that there is a sixth factor, inflammation; and that it is critical to both the development and the progression of atherosclerosis to heart attack.”
Mehta and colleagues conducted a prospective observational study of 121 patients with moderate to severe psoriasis and low risk for CVD (mean age, 51 years; 58% men; median Framingham risk score, 3), who completed 1-year follow-up and had not had biologic treatment at baseline. During the study period, 89 patients were treated with biologic therapy.
All patients underwent coronary CTA at baseline and 1 year to quantify total plaque coronary burden and plaque subcomponents in three coronary vessels of at least 2 mm in diameter.
According to the researchers, biologic therapy was associated with reductions in noncalcified plaque burden (6%; P = .005) and necrotic core (57%; P = .03), but not in fibrous burden (P = .71).
Compared with patients who were not treated with biologics, those who were had a greater decrease in noncalcified plaque burden (–0.07 mm2 vs. 0.06 mm2; P = .02), which persisted after adjustment for traditional CV risk factors (beta = 0.2; P = .02), Mehta and colleagues wrote.
The group treated with biologics had a reduction in C-reactive protein at 1 year (P < .001), but the untreated group did not (P = .21).
The treatment effect was greatest in patients treated with anti-interleukin-17 therapy, according to the researchers.
“We found that these anti-inflammatory drugs commonly used to treat severe psoriasis also improve plaque in the coronary artery, making them more stable and less likely to cause a heart attack. This occurred in the absence of changes in traditional cardiovascular risk factors including blood pressure and blood lipids,” Mehta said in a press release from the European Society of Cardiology. “This preliminary study provides the first evidence that biologic therapy is associated with coronary plaque reduction and stabilization, and provides strong rationale for conduct of a randomized trial testing the impact of biologic therapy on the progression of coronary disease in patients with psoriasis.” – by Erik Swain
Disclosures: Mehta reports he received research grants to his employer, the NHLBI, from AbbVie, Celgene, Janssen and Novartis. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Paul M. Ridker, MD, MPH
After CANTOS, we are in an entirely new therapeutic era where inflammation inhibition has been proven to lower vascular event rates without changing cholesterol or BP.
What we need now are model systems where the intersection between inflammation and atherosclerosis can be carefully studied, and psoriasis patients a terrific model for this purpose.
These observational data in patients with psoriasis are provocative and exciting, and clearly support future randomized trials.
Patients with residual inflammatory risk are quite common but need therapeutic strategies that go beyond cholesterol if we are to prevent their recurrent vascular events.
Harvard Medical School
Director, Center for Cardiovascular Disease Prevention
Brigham and Womens Hospital
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