February 11, 2019Cardiology
More than 15 million Americans, and many more worldwide, suffer from atherosclerotic cardiovascular disease. Heart attack occurs in 750,000 individuals every year in the United States; globally, more than 7 million people had heart attacks in 2015.
Psoriasis, a common skin disease affecting 3-5% of the U.S. population, is associated with heightened systemic inflammation, which elevates risk of blood vessel disease and diabetes. Inflammation occurs when the body's defensive mechanism kicks in to ward off infection or disease, but this mechanism can turn against itself when triggered, for instance, by excess low-density lipoproteins (LDLs) that seep into the lining of the arteries. The resulting inflammatory response can cause blood clots, which block arteries and can lead to heart attack and stroke. Inflammation puts 20-30% of the U.S. population at risk for these kinds of events. People with inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, and psoriasis have a much higher rate of cardiovascular events.
According to an article published in Cardiovascular Research (28 January 2019), it was reported that treating psoriasis, a chronic inflammatory skin disease, with biologic drugs that target immune system activity can reduce the early plaque buildup that clogs arteries, restricts blood flow, and leads to heart attacks and stroke. The findings highlight how immunotherapies that treat inflammatory conditions might play a role in the reduction of cardiovascular disease risks. This is the first in-human evidence that treatment of a known inflammatory condition with biologic therapy, a type of drug that suppresses the immune system, was associated with a reduction in coronary artery disease, in particular of rupture prone plaque which often leads to a heart attack.
The current findings came from an observational study of the NIH Psoriasis Atherosclerosis Cardiometabolic Initiative cohort, which had 290 psoriasis patients, 121 of whom suffered moderate to severe skin disease and qualified for the biologic therapy approved by the FDA. For a year, the authors followed the eligible patients, all of whom had low cardiovascular risk, and compared them to those who elected not to receive biologic therapy. Study results show that biologic therapy was associated with an 8% reduction in coronary artery plaque. Prior research had linked psoriasis with premature development of high-risk coronary plaque. The current study shows beneficial changes in this plaque when psoriasis is treated with biologic therapy - even without changes in other cardiovascular risk factors such as cholesterol, glucose, and blood pressure. According to the authors, the improvement in the patients' soft-plaque appears to be an anti-inflammatory effect in the absence of improvement in other cardiovascular risk factors, and without adding new cholesterol medications. The only change was the severity of their skin disease.