National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
JAMA Cardiol. 2019 Sep 1;4(9):885-891. doi: 10.1001/jamacardio.2019.2589.
Psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events. Biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, but it is unclear whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries.
To investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA).
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study performed from January 1, 2013, through March 31, 2019, analyzed changes in FAI in patients with moderate to severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline.
Biologic therapy for psoriasis.
Perivascular FAI mapping was performed based on an established method by a reader blinded to patient demographics, visit, and treatment status.
Of the 134 patients (mean [SD] age, 51.1 [12.1] years; 84 [62.5%] male), most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate to severe skin disease. Of these patients, 82 received biologic psoriasis therapy (anti-tumor necrosis factor α, anti-interleukin [IL] 12/23, or anti-IL-17) for 1 year, and 52 did not receive any biologic therapy and were given topical or light therapy (control group). At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque. Biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI -71.22 HU [interquartile range (IQR), -75.85 to -68.11 HU] at baseline vs -76.09 HU [IQR, -80.08 to -70.37 HU] at 1 year; P < .001) concurrent with skin disease improvement (median PASI, 7.7 [IQR, 3.2-12.5] at baseline vs 3.2 [IQR, 1.8-5.7] at 1 year; P < .001), whereas no change in FAI was noted in those not receiving biologic therapy (median FAI, -71.98 [IQR, -77.36 to -65.64] at baseline vs -72.66 [IQR, -78.21 to -67.44] at 1 year; P = .39). The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents, including anti-tumor necrosis factor α (median FAI, -71.25 [IQR, -75.86 to -66.89] at baseline vs -75.49 [IQR, -79.12 to -68.58] at 1 year; P < .001) and anti-IL-12/23 or anti-IL-17 therapy (median FAI, -71.18 [IQR, -75.85 to -68.80] at baseline vs -76.92 [IQR, -81.16 to -71.67] at 1 year; P < .001).
In this study, biologic therapy for moderate to severe psoriasis was associated with reduced coronary inflammation assessed by perivascular FAI. This finding suggests that perivascular FAI measured by CCTA may be used to track response to interventions for coronary artery disease.
重要性：银屑病是一种慢性炎症性皮肤疾病，与冠状动脉斑块负荷增加和心血管事件相关。已发现生物疗法治疗银屑病与管腔冠状动脉斑块呈有利关联，但尚不清楚这些关联是否归因于对冠状动脉的直接抗炎作用。
目的：通过使用新的成像生物标志物血管周围脂肪衰减指数（FAI）来研究生物疗法治疗银屑病患者的冠状动脉炎症，该生物标志物通过冠状动脉计算机断层血管造影术（CCTA）来评估冠状动脉炎症，通过对血管周围脂肪成分的空间变化进行映射。
设计、设置和参与者：这项前瞻性队列研究于 2013 年 1 月 1 日至 2019 年 3 月 31 日进行，分析了基线时接受 CCTA 检查且未接受生物性银屑病治疗的中度至重度银屑病患者在基线时和 1 年后的 FAI 变化。
暴露：生物性银屑病治疗。
主要结果和测量：根据一种既定方法进行血管周围 FAI 映射，由一位对患者人口统计学、就诊和治疗情况不知情的读者进行。
结果：在 134 名患者（平均[标准差]年龄，51.1[12.1]岁；84[62.5%]为男性）中，大多数患者的传统风险评分（中位Framingham 10 年风险评分，3%[四分位间距，1%-7%]）和皮肤疾病严重程度较低。这些患者中，82 人接受了为期 1 年的生物性银屑病治疗（抗肿瘤坏死因子α、抗白细胞介素[IL]12/23 或抗 IL-17），52 人未接受任何生物治疗，给予局部或光疗（对照组）。基线时，46 名患者（治疗组 27 名，未治疗组 19 名）存在局灶性冠状动脉粥样硬化斑块。生物治疗与 FAI 在 1 年内的显著降低相关（中位数 FAI：基线时为-71.22 HU[四分位间距，-75.85 至-68.11 HU]，1 年时为-76.09 HU[四分位间距，-80.08 至-70.37 HU]；P<0.001），同时皮肤疾病得到改善（中位数 PASI，基线时为 7.7[四分位间距，3.2-12.5]，1 年时为 3.2[四分位间距，1.8-5.7]；P<0.001），而未接受生物治疗的患者的 FAI 无变化（中位数 FAI：基线时为-71.98 HU[四分位间距，-77.36 至-65.64 HU]，1 年时为-72.66 HU[四分位间距，-78.21 至-67.44 HU]；P=0.39）。这些与 FAI 的关联独立于冠状动脉斑块的存在，并且在接受不同生物制剂治疗的患者中是一致的，包括抗肿瘤坏死因子α（中位数 FAI：基线时为-71.25 HU[四分位间距，-75.86 至-66.89 HU]，1 年时为-75.49 HU[四分位间距，-79.12 至-68.58 HU]；P<0.001）和抗 IL-12/23 或抗 IL-17 治疗（中位数 FAI：基线时为-71.18 HU[四分位间距，-75.85 至-68.80 HU]，1 年时为-76.92 HU[四分位间距，-81.16 至-71.67 HU]；P<0.001）。
结论和相关性：在这项研究中，生物性银屑病的中度至重度治疗与通过血管周围 FAI 评估的冠状动脉炎症减少相关。这一发现表明，CCTA 测量的血管周围 FAI 可能用于跟踪对冠状动脉疾病干预措施的反应。
