Psoriasis Severity Could Signal Increased Cardiovascular Risk

Stefano Piaserico, MD, PhD
Credit: International Psoriasis Council

A new study is calling attention to the potential increase in risk for coronary microvascular dysfunction among patients with severe psoriasis.

In what investigators call the largest study to date exploring the relationship between severe psoriasis and coronary microvascular dysfunctional results indicate the prevalence of microvascular dysfunction was 3 in 10 among asymptomatic patients with severe psoriasis, with each increase in Psoriasis Area Severity Index (PASI) score and each additional year in disease duration associated with an incremental increase in risk of coronary microvascular dysfunction.¹

"Previous studies have shown that patients with severe psoriasis have an increased cardiovascular morbidity and mortality. However, there has been limited research on the specific mechanisms underlying this increased risk, particularly regarding coronary microvascular dysfunction,” explained lead investigator Stefano Piaserico, MD, PhD, Dermatology Unit, Department of Medicine, University of Padova.² “We wanted to further investigate the prevalence of coronary microvascular dysfunction, as assessed by coronary flow reserve (CFR), in a large cohort of patients with severe psoriasis and its association with psoriasis severity and duration, as well as other patient characteristics."

Citing limitations related to size for previous research examining the link between severe psoriasis and coronary microvascular dysfunction, Piaserico and a team of colleagues designed the current research endeavor to be a more extensive, prospective, multicenter study on a larger population of patients with severe psoriasis. The specific intent of the investigators' study was to assess the prevalence of reduced coronary flow reserve (CFR), which was measured using transthoracic Doppler echocardiography to evaluate coronary microcirculation.¹

Investigators assessed a cohort of 503 patients for inclusion in the trial. Of the 503 who were reenrolled, 55 were excluded based on missing or unavailable data. Among the 448 patients identified for inclusion, 68.8% were male, the mean age was 45.75 (Standard deviation [SD], 13.33) years, the mean PASI score at baseline was 12.00 (SD, 8.71), and the mean duration of psoriasis was 15.17 (SD, 12.33) years.¹

Upon analysis, results indicated 31.5% of the cohort had a CFR of 2.5 or less, which indicates the presence of coronary microvascular dysfunction. Investigators highlighted none of these patients had coronary stenoses at the time of the multislice computed tomography scans. Further analysis suggested 12.9% of the cohort had CFR of 2.0 or less and 5.1% had a CFR of 1.5 or less.¹

Relative to their counterparts with severe psoriasis but without coronary microvascular dysfunction, those with coronary microvascular dysfunction were older (42.73 [SD, 12.85] vs 50.4 [SD, 12.78]), had a slightly higher body mass index (28.52 [SD, 5.85] vs 29.89 [SD, 6.70]), had a greater PASI score (10.82 [SD, 7.61] vs 13.45 [SD, 10.32]), and were more often affected by hypertension(19.5% vs 34%) and psoriatic arthritis (26.7% vs 43.3%).¹

Results of a multilinear regression analysis revealed higher PASI, longer duration of psoriasis, the presence of psoriatic arthritis, and hypertension were significantly associated with lower CFR. Investigators highlighted each 1-point increase in PASI and 1 year of psoriasis duration were associated with a 5.8% and 4.6% increased risk of coronary microvascular dysfunction, respectively.¹

"We should diagnose and actively search for microvascular dysfunction in patients with psoriasis, as this population is at particularly high risk. We might hypothesize that an early and effective treatment of psoriasis would restore the dysfunction and eventually prevent the future risk of myocardial infarction and heart failure associated with it,” Piaserico added.²

References:

1. Piaserico S, Papadavid E, Cecere A, et al. Coronary microvascular dysfunction in asymptomatic patients with severe psoriasis. Journal of Investigative Dermatology. 2023;143(10). doi:10.1016/j.jid.2023.02.037
2. Elsevier News. New evidence confirms patients with severe psoriasis are at a higher risk for heart disease. EurekAlert! September 20, 2023. Accessed September 21, 2023. https://www.eurekalert.org/news-releases/1001707.