The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events

J Am Acad Dermatol. 2017 Oct;77(4):650-656.e3. doi: 10.1016/j.jaad.2017.06.028. Epub 2017 Aug 18.

Abstract

Background: Psoriasis is associated with risk of cardiovascular (CV) disease (CVD) and a major adverse CV event (MACE). Whether psoriasis duration affects risk of vascular inflammation and MACEs has not been well characterized.

Objectives: We utilized two resources to understand the effect of psoriasis duration on vascular disease and CV events: (1) a human imaging study and (2) a population-based study of CVD events.

Methods: First, patients with psoriasis (N = 190) underwent fludeoxyglucose F 18 positron emission tomography/computed tomography (duration effect reported as a β-coefficient). Second, MACE risk was examined by using nationwide registries (adjusted hazard ratios in patients with psoriasis (n = 87,161) versus the general population (n = 4,234,793).

Results: In the human imaging study, patients were young, of low CV risk by traditional risk scores, and had a high prevalence of cardiometabolic diseases. Vascular inflammation by fludeoxyglucose F 18 positron emission tomography/computed tomography was significantly associated with disease duration (β = 0.171, P = .002). In the population-based study, psoriasis duration had strong relationship with MACE risk (1.0% per additional year of psoriasis duration [hazard ratio, 1.010; 95% confidence interval, 1.007-1.013]).

Limitations: These studies utilized observational data.

Conclusion: We found detrimental effects of psoriasis duration on vascular inflammation and MACE, suggesting that cumulative duration of exposure to low-grade chronic inflammation may accelerate vascular disease development and MACEs. Providers should consider inquiring about duration of disease to counsel for heightened CVD risk in psoriasis.

Keywords: 18-FDG PET/CT; cardiovascular disease; inflammation; psoriasis.

MeSH terms

  • Adult
  • Aged
  • Brain Ischemia / complications
  • Brain Ischemia / epidemiology
  • Case-Control Studies
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / mortality
  • Positron Emission Tomography Computed Tomography
  • Psoriasis / epidemiology*
  • Radiopharmaceuticals
  • Registries
  • Stroke / epidemiology*
  • Stroke / etiology
  • Stroke / mortality
  • Time Factors
  • United States / epidemiology
  • Vasculitis / diagnostic imaging
  • Vasculitis / epidemiology*

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18