Women's College Hospital and University of Toronto, Toronto, Ontario, Canada.
National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
Arthritis Rheumatol. 2018 Mar;70(3):408-416. doi: 10.1002/art.40366. Epub 2018 Feb 6.
To assess the effect of tumor necrosis factor inhibitors (TNFi) on subclinical cardiovascular disease in patients with psoriatic disease.
We performed a 2-stage study. In stage 1, carotid total plaque area was assessed in patients with psoriasis or psoriatic arthritis (PsA) (n = 319) by ultrasound at baseline and after 2-3 years. The annual progression rate of atherosclerosis was the outcome of interest. In stage 2, PsA patients receiving TNFi (n = 21) and age- and sex-matched PsA patients not receiving any biologic agent (n = 13) underwent F-fluorodeoxyglucose-positron emission tomography/computed tomography at baseline and 1 year to assess vascular inflammation, measured as target-to-background ratio (TBR). In both stages, multivariable regression analyses adjusted for cardiovascular risk factors and use of statins were performed.
In stage 1, men had significantly higher atherosclerosis progression than women (P < 0.001). TNFi was associated with reduced atherosclerosis progression in men after controlling for cardiovascular risk and use of statins (adjusted β = -2.20 [95% confidence interval -3.41, -1.00], P < 0.001). There was no association between TNFi and atherosclerosis progression in women (P = 0.74). In stage 2, patients receiving TNFi had reduced TBR at 1 year (P = 0.03). Those not receiving TNFi had no significant change in TBR (P = 0.32). The improvement in aortic vascular inflammation in the TNFi group was independent of cardiovascular risk factors (adjusted β = -0.41 [95% confidence interval -0.74, -0.08], P = 0.02).
Our findings indicate that TNFi treatment is associated with reduced progression of carotid plaques in men and improvement in vascular inflammation in both men and women with psoriatic disease.
评估肿瘤坏死因子抑制剂（TNFi）对银屑病患者亚临床心血管疾病的影响。
我们进行了一项两阶段研究。在第一阶段，通过超声在基线和 2-3 年后评估银屑病或银屑病关节炎（PsA）患者（n = 319）的颈动脉总斑块面积。动脉粥样硬化的年进展率是研究的结果。在第二阶段，接受 TNFi 的 PsA 患者（n = 21）和年龄及性别匹配的未接受任何生物制剂的 PsA 患者（n = 13）在基线和 1 年时接受 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描，以评估血管炎症，以靶标与背景比（TBR）衡量。在两个阶段，均进行了多变量回归分析，调整了心血管危险因素和他汀类药物的使用。
在第一阶段，男性的动脉粥样硬化进展明显高于女性（P < 0.001）。在控制心血管风险和他汀类药物使用后，TNFi 与男性动脉粥样硬化进展减少相关（调整后的β= -2.20 [95%置信区间 -3.41，-1.00]，P < 0.001）。TNFi 与女性的动脉粥样硬化进展无关（P = 0.74）。在第二阶段，接受 TNFi 的患者在 1 年内 TBR 降低（P = 0.03）。未接受 TNFi 的患者 TBR 无明显变化（P = 0.32）。TNFi 组主动脉血管炎症的改善与心血管危险因素无关（调整后的β= -0.41 [95%置信区间 -0.74，-0.08]，P = 0.02）。
我们的研究结果表明，TNFi 治疗与男性颈动脉斑块进展减少以及男性和女性银屑病患者血管炎症改善相关。
