Asymptomatic coronary microvascular dysfunction risk increased for patients with psoriasis

Key takeaways:

• Almost one-third of patients with psoriasis also had coronary microvascular dysfunction (CMD).
• Psoriasis severity and duration were independent risk factors of CMD.

Patients with psoriasis are at an increased risk for experiencing asymptomatic coronary microvascular dysfunction and should be actively evaluated for risk factors by dermatologists, according to a study.

“Patients affected by severe psoriasis suffer from increased cardiovascular morbidity and mortality owing to accelerated atherosclerosis and premature coronary artery disease,” Stefano Piaserico, MD, PhD, of the dermatology unit of the department of medicine at the University of Padova in Italy, and colleagues wrote. “This excess risk has been attributed to psoriasis-induced inflammation.”

Coronary microvascular dysfunction (CMD), characterized by an abnormal regulation of the coronary microcirculation, is known to predict poor cardiovascular prognosis in the general population. One of the best ways to clinically measure the presence of CMD is to evaluate a patient’s coronary flow reserve (CFR). The lower the CFR levels, the higher risk for myocardial infarction and death, according to the researchers.

Since patients with psoriasis are at a heightened risk for cardiovascular disease, Piaserico and colleagues set out to find the prevalence and predictors of CMD in patients with psoriasis.

A total of 448 patients (mean age, 45 years; 69% male) underwent transthoracic Doppler echocardiography to evaluate coronary microcirculation, a tell-tale sign of CMD.

Results showed that almost one-third of patients (31.5%) with psoriasis had a CFR of 2.5 or less, which indicated CMD. Further, 12.9% of the cohort had a CFR of 2 or less, and 5.1% had a “severely reduced” CFR cut-off of 1.5 or less, according to the researchers.

Compared with those that did not have CMD, those with CMD had longer psoriatic disease duration (18.91 ± 13.53 vs. 12.38 ± 10.86; P < .001), hypertension (34% vs. 19.5%; P < .001) and psoriatic arthritis (43.3% vs. 26.7%; P < .001). These patients also experienced higher PASI scores (13.45 ± 10.32 vs. 10.82 ± 7.61; P < .004).

The researchers also found that for every 1-point increase of PASI and every additional year of psoriasis duration, patients experienced a 5.8% and 4.6% increased risk for CMD, respectively.

“Our findings extend the observations of earlier small studies by showing a high prevalence of coronary microvascular dysfunction in asymptomatic patients with severe psoriasis and by showing that the excess microvascular dysfunction is independently associated with the severity and duration of psoriasis,” Piaserico and colleagues wrote.

According to the authors, this finding is consistent with the idea that inflammation from psoriasis is a key contributor to CMD risk.

“Accordingly, we should diagnose and actively search for microvascular dysfunction in patients with psoriasis, as this population is at particularly high risk,” they concluded.