A New “Vein” of Thought: Psoriasis Severity May Be Linked to Vascular Inflammation

It probably doesn’t come as a surprise to anyone living with psoriasis to hear that psoriasis frequently comes with cardiovascular complications, or comorbidity.  It has been reported that people with severe psoriasis can have up to a 58% increased risk of major cardiovascular complications, including heart attack (myocardial infarction), narrowing of arteries (atherosclerosis), and heart disease, and may experience up to a 57% increased risk of cardiovascular complications that lead to death.1  This increased risk can be cause for considerable concern, but what is less clear is exactly how and why the connection between psoriasis and vascular inflammation is caused. Since psoriasis is an autoimmune disease, one of its classic characteristics is chronic inflammation. The chronic inflammation that affects skin is visible whereas vascular inflammation is hidden.

What does the research tell us?

Much of today’s current psoriasis research has been dedicated to finding connections between psoriasis (and its treatments) and obesity, psoriatic arthritisvascular inflammation, and other pre-cardiovascular conditions, or major cardiovascular events. In general, research shows that the risk of cardiovascular disease increases with greater psoriasis and psoriatic disease severity.

One recent study of note, led by Haley B. Naik, and funded by the National Heart, Lung and Blood Institute (NHLBI), takes a closer look at vascular inflammation, an indicator of potential cardiovascular complications, and its ties to psoriasis.2  The researchers utilized a PET/CT scan with a relatively new technique to detect inflammation, called 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT). The FDG PET/CT scan technique has been shown to more accurately measure metabolic activity of cells, allowing researchers to detect inflammation sooner and in a more robust manner.3

A deeper dive...

The study followed 60 adult individuals with mild to moderate psoriasis severity (as determined by the Psoriasis Area Severity Index), and 20 adults without the condition were analyzed using the FDG PET/CT technique and vascular inflammation was measured using an average Aortic Target-to-Background Ratio.  What the researchers ultimately found, was that increasing aortic target-to-background ratios were associated with an increase in psoriasis area index scores.  Essentially, the more severe the psoriasis symptoms in an individual, the greater the amount of vascular inflammation.  High levels of vascular inflammation are an indicator of current, or predictor of future cardiovascular complications.

Specifically, the researchers found an increase in pro-inflammatory factors--neutrophil concentration and production (white blood cells that respond to inflammation and are also present in psoriasis plaques), as well as an increase in the level of S100A8/A9 protein in the blood (a protein that is believed to help create and circulate neutrophils, indicating inflammation), for those with psoriasis.  Additional interleukins and Tumor Necrosis Factor (TNF) alpha were found in those with psoriasis, also indicating and increase in inflammation that is attributable to psoriasis.

Even after adjusting for all confounding variables, the association of the severity of psoriasis with the severity of vascular inflammation in an individual remained strong. The vascular inflammation was seen throughout the body, not just at body sites where there were more severe psoriasis plaques. While it is still a mystery exactly why similar mechanisms are observed in psoriasis plaques and vascular inflammation sites elsewhere in the body, this information adds to the growing body of research on psoriasis and cardiovascular complications.  Studies like this one can provide a step towards reducing the risk of severe and life-threatening complications for those with psoriasis.

Other studies have recently been published that compare the levels of vascular inflammation amongst individuals with psoriasis versus those with other inflammatory conditions such as rheumatoid arthritis, as well as studies investigating the specific type, size, and shape of cholesterol particles in those with psoriasis.4,5 An additional study at the University of Pennsylvania is currently underway and is set to conclude in July 2017, furthering the body of research on psoriasis severity and its association with vascular inflammation.That study will also test specific treatments to see if they will lower vascular inflammation and improve lipid metabolism.

What does it all mean?

Ultimately, this is a growing field of research and will most likely be the focus of many peer-reviewed articles and clinical trials in the near future for us to learn from!  As more evidence of this type confirms the correlation between psoriasis and vascular inflammation, healthcare providers will be able to develop more clear screening guidelines which will help to intervene with cardiovascular problems before they become more advanced or life-threatening. This research will hopefully also help develop treatments that can reduce psoriasis inflammation and flare-ups while at the same time reducing vascular inflammation. At a minimum, healthcare providers for people with psoriasis and psoriatic arthritis should conduct frequent screening of their patients for cardiovascular risk factors.

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