Biologic therapy for psoriasis – protein-based infusions to suppress inflammation – was associated with a significant reduction in high-risk plaque in heart arteries, over one year, according to new research published in Circulation: Cardiovascular Imaging, an American Heart Association journal.

The positive association between biologic therapy and a decrease in high-risk plaque in heart arteries was significant after adjusting for cardiovascular risk factors and psoriasis severity.

Chronic inflammation in people with psoriasis is associated with a higher risk of developing coronary artery disease. Biologic therapy medications are proteins that are given by injection or infusion and suppress the inflammation process by blocking the action of cytokines, which are proteins that promote systemic inflammation.

Psoriasis Linked to Development of Plaque

Previous research has shown a clear link between psoriasis and the development of high-risk coronary plaque. This study provides characterization of a lipid-rich necrotic core, a dangerous type of coronary plaque made up of dead cells and cell debris that is prone to rupture. Ruptured plaque can lead to a heart attack or stroke, a media release from the American Heart Association explains.

“Having inflamed plaque that is prone to rupture increases the risk of heart attack five-fold within ten years.

“This is the first time an imaging study in humans has shown what 1 year of ongoing, untreated inflammation can do to arteries of the heart and that we can reverse this damage. Untreated inflammation is dangerous. You are just waiting for a heart attack or stroke to happen.”

— Nehal N. Mehta, MD, MSCE, FAHA, study senior author, a Lasker Senior Investigator and chief of the Lab of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute at the National Institutes of Health in Bethesda, Maryland

The analysis involved 209 middle-aged patients (ages 37-62) with psoriasis who participated in the Psoriasis Atherosclerosis Cardiometabolic Initiative at the National Institutes of Health, an ongoing observational study. Of these participants, 124 received biologic therapy, and 85 were in the control group, treated only with topical creams and light therapy.

To measure the effects of biologic therapy on arteries of the heart, the researchers performed cardiac computed tomography (CT) scans on all study participants before they started therapy and 1 year later. The CT results between the two groups were then compared.

At the start of the study, participants with psoriasis had low cardiovascular risk by conventional cardiovascular risk scores, and severe psoriasis was associated with higher body mass index (BMI), high-sensitivity C-reactive protein (a measure of systemic inflammation) and higher levels of coronary artery plaque.

Study Findings

After 1 year of treatment, patients who received biologic therapy were compared to the control group. Researchers found the following, the release continues:

• Biologic therapy was associated with an 8% reduction in coronary plaque. In contrast, those in the control group experienced slightly increased coronary plaque progression.
• Even after adjusting for cardiovascular risk factors and psoriasis severity, patients treated with biologic therapy had reduced coronary plaque.

“There is approximately 6-8% reduction in coronary plaque following therapy with statins. Similarly, our treatment with biologic therapy reduced coronary plaque by the same amount after one year. These findings suggest that biologic therapy to treat psoriasis may be just as beneficial as statin therapy on heart arteries.”

— Nehal N. Mehta, MD, MSCE, FAHA

Treat Psoriasis and Heart Disease with One Therapy?

This study has implications for people with psoriasis and possibly for people with other chronic inflammatory conditions such as HIV, lupus and rheumatoid arthritis, who also have increased risk of heart disease.

“We have never before been able to show healing of an inflamed plaque like this in humans. Biologic therapy reduces systemic inflammation and immune activation, and it has a favorable impact on improving overall vascular health. Imagine if we can treat both psoriasis and coronary heart disease with one therapy — that is the question to be asked in future studies.”

— Nehal N. Mehta, MD, MSCE, FAHA

The study’s findings should be interpreted with caution because it was limited by a short follow-up period and a relatively small number of patients, the release cautions.

Larger, randomized controlled studies are needed to better understand how changes in coronary plaque may lead to a reduction in heart attacks and strokes in people with psoriasis.

[Source(s): American Heart Association, Science Daily]

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