Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.
Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study.
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DOI：
10.1161/circulationaha.116.026859
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发表时间：
2017-07-18
期刊：
影响因子：
37.8
通讯作者：
Mehta NN
中科院分区：
文献类型：
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作者：
Lerman JB;Joshi AA;Chaturvedi A;Aberra TM;Dey AK;Rodante JA;Salahuddin T;Chung JH;Rana A;Teague HL;Wu JJ;Playford MP;Lockshin BA;Chen MY;Sandfort V;Bluemke DA;Mehta NN
银屑病是一种慢性炎症性疾病，与MI的风险增加有关，为研究体内炎性动脉粥样硬化提供了理想的人体模型。我们假设，银屑病患者心血管风险增加部分归因于亚临床冠状动脉疾病（CAD）负担升高，包括具有高风险特征的非钙化斑块。然而，还没有做出足够的努力来直接测量CAD在这个脆弱的人群。因此，我们试图比较银屑病患者（n=105）、根据NCEP-ATP III指南符合他汀类药物治疗资格的高脂血症患者（n= 100）（年龄约10岁）和非银屑病健康志愿者（HV）（n=25）之间的总（TB）和非钙化（NCB）冠状动脉斑块负荷以及高危斑块（HRP）患病率。患者接受冠状动脉计算机断层扫描血管造影（CCTA）进行TB和NCB定量，HRP识别，定义为低衰减（<30 HU），阳性重塑（>1.10）和点状钙化。在治疗后1年再次扫描前50名银屑病患者的连续样本。尽管与高脂血症患者相比，银屑病患者更年轻且传统风险更低，但其NCB增加（平均值±S.D.：1.18±0.33 vs 1.11±0.32，p=0.02），以及相似的HRP患病率（p=0.58）。此外，与HV相比，银屑病患者的TB（1.22±0.31 vs 1.04±0.22，p=0.001）、NCB（1.18±0.33 vs 1.03±0.21，p=0.004）和HRP患病率高于传统风险（OR=6.0，95% CI：1.1-31.7; p=0.03）。最后，在随访1年的银屑病患者中，银屑病严重程度的改善与TB（β=0.45，0.23-0.67; p<0.001）和NCB（β=0.53，0.32-0.74; p<0.001）的改善相关，超出了传统的风险因素。银屑病患者的NCB和HRP患病率高于HV。此外，银屑病患者的NCB升高，HRP患病率与老年高脂血症患者相当。最后，调节靶器官炎症（例如，皮肤）与1年时NCB的改善相关，表明控制远端炎症部位可转化为降低CAD风险。
Psoriasis, a chronic inflammatory disease associated with an accelerated risk of MI, provides an ideal human model to study inflammatory atherogenesis in vivo. We hypothesized that the increased cardiovascular risk observed in psoriasis would be partially attributable to an elevated subclinical coronary artery disease (CAD) burden composed of non-calcified plaques with high-risk features. However, inadequate efforts have been made to directly measure CAD in this vulnerable population. As such, we sought to compare total (TB) and non-calcified (NCB) coronary plaque burden, and high-risk plaque (HRP) prevalence, between psoriasis patients (n=105), hyperlipidemic patients eligible for statin therapy under NCEP-ATP III guidelines (n=100) who were ~10 years older, and non-psoriasis healthy volunteers (HV) (n=25). Patients underwent coronary computed-tomography angiography (CCTA) for TB and NCB quantification, and HRP identification, defined as low-attenuation (<30 HU), positive remodeling (>1.10), and spotty calcification. A consecutive sample of the first 50 psoriasis patients were scanned again at 1 year following therapy. Despite being younger and at lower traditional risk than hyperlipidemic patients, psoriasis patients had increased NCB (mean±S.D.:1.18±0.33 vs 1.11±0.32, p=0.02), and similar HRP prevalence (p=0.58). Furthermore, compared to HV, psoriasis patients had increased TB (1.22±0.31 vs 1.04±0.22, p=0.001), NCB (1.18±0.33 vs 1.03±0.21, p=0.004), and HRP prevalence beyond traditional risk (OR=6.0, 95% CI: 1.1–31.7; p=0.03). Finally, amongst psoriasis patients followed for 1-year, improvement in psoriasis severity associated with improvement in TB (β=0.45, 0.23–0.67; p<0.001) and NCB (β=0.53, 0.32–0.74; p<0.001) beyond traditional risk factors. Psoriasis patients had greater NCB and increased HRP prevalence than HV. Additionally, psoriasis patients had elevated NCB and equivalent HRP prevalence as older, hyperlipidemic patients. Finally, modulation of target organ inflammation (eg. skin) associated with an improvement in NCB at 1 year, suggesting that control of remote sites of inflammation may translate into reduced CAD risk.