In a large cross-sectional study, nearly one-third of patients with severe psoriasis met criteria for coronary microvascular dysfunction, with the authors suggesting the need for increased detection and diagnosis in these patients, as this population is at particularly high risk.
The study was led by Dr Stefano Piaserico of the University of Padova, Italy, and published in the Journal of Investigative Dermatology.
Prior studies with small sample sizes have shown that coronary microvascular dysfunction (CMD) predicts poor cardiovascular outcomes in patients with severe psoriasis.
Medscape reports that in their prospective multi-centre study, the researchers enrolled 448 patients with moderate to severe psoriasis, with no documented clinical cardiovascular disease, who underwent transthoracic Doppler echocardiography to evaluate coronary microcirculation.
The outcome variable of interest was CMD, defined as a coronary flow rate ≤ 2.5 mL.
The team used multivariable linear regression to model the associations of the characteristics of patients with psoriasis with CMD.
Of the 448 patients, 141 (31.5%) showed CMD.
Multivariable regression revealed four variables independently associated with CMD: higher psoriasis area severity index (PASI) score (per unit, odds ratio [OR], 1.058; P < .001), duration of psoriasis (per year; OR, 1.046; P < .001), the presence of psoriatic arthritis (OR, 1.938; P = .015), and hypertension (OR, 2.169; P = .010).
An increase of 1 point in the PASI score and one year of psoriasis duration were associated with a 5.8% and a 4.6% increased risk for CMD, respectively.
Limitations, said the study authors, included that a small proportion of patients in the study were being treated for psoriasis, and other tools for assessing CMD were not used, such as PET-CT and cardiovascular MRI.
Study details
Coronary microvascular dysfunction in asymptomatic patients with severe psoriasis
Stefano Piaserico, Evangelia Papadavid, Ignatios Ikonomidis, et al.
Published in Journal of Investigative Dermatology in October 2023
Summary
Severe psoriasis is associated with an increased cardiovascular risk, which may be independent of the traditional risk factors. Coronary microvascular dysfunction (CMD) has been shown to predict a poor cardiovascular prognosis in the general population and in patients with psoriasis. In this study, we assessed the prevalence and predictors of CMD in a large cohort of patients with psoriasis without clinical cardiovascular disease. A total of 503 patients with psoriasis were enrolled and underwent transthoracic Doppler echocardiography to evaluate coronary microcirculation. Of these, 55 patients were excluded from the analyses because of missing data. Of the 448 patients in this study, 31.5% showed CMD. Higher PASI, longer disease duration, the presence of psoriatic arthritis, and hypertension were independently associated with CMD. An increase of 1 point of PASI and 1 year of psoriasis duration were associated with a 5.8% and 4.6% increased risk of CMD, respectively. In our study, CMD was associated with the severity and duration of psoriasis. This supports the role of systemic inflammation in CMD and suggests that the coronary microcirculation may represent an extra-cutaneous site involved in the immune-mediated injury of psoriasis. We should diagnose and actively search for CMD in patients with severe psoriasis.
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