Study Links Psoriasis Therapy to Improved Heart Disease
Researchers have found that treating psoriasis with biologic drugs that target inflammation can reduce the early plaque buildup that clogs arteries restricts blood flow and leads to myocardial infarctions and stroke.
During one year of treatment, biologic therapy improved coronary artery plaque similar to the effect of a low-dose statin. The findings highlight how immunotherapies that treat inflammatory conditions might play a role in the reduction of cardiovascular disease risks (Cardiovascular Research cvz009. Published online Feb. 5, 2019).
“Classically a heart attack is caused by one of five risk factors: diabetes, hypertension, high cholesterol, family history or smoking,” said Nehal N. Mehta, MD, head of the Lab of Inflammation and Cardiometabolic Diseases at NHLBI. “Our study presents evidence that there is a sixth factor, inflammation; and that it is critical to both the development and the progression of atherosclerosis to heart attack.”
Now researchers provided first in-human evidence that treatment of a known inflammatory condition with biologic therapy, which 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 plaque psoriasis and qualified for an FDA approved biologic therapy.
Researchers followed the eligible patients for one year, all of whom had low cardiovascular risk, and compared them to those who elected not to receive biologic therapy. They found that biologic therapy was associated with an 8% reduction in coronary artery plaque.
“The findings that intrigued us most were that coronary plaque sub-components changed over one year, including the necrotic core and non-calcified components, which are the culprits for most heart attacks,” Mehta said.
Prior research had linked psoriasis with premature development of high-risk coronary plaque. Now, Mehta’s team has shown 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. The make-up of coronary plaques also improved in those taking biologics, making them less risky. The coronary plaque burden increased by 2% in patients who did not take a biologic.
“This appears to be an anti-inflammatory effect. In the absence of improvement in other cardiovascular risk factors, and without adding new cholesterol medications, patients’ soft-plaque still improved. The only change was the severity of their skin disease,” Dr. Mehta said.
Psoriasis, a common skin disease affecting 3% to 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.
Inflammation puts 20% to 30% of the U.S. population at risk for cardiovascular events. People with inflammatory diseases, such as rheumatoid arthritis, systemic lupus erythematous and psoriasis have a much higher rate of cardiovascular events. Young patients with severe psoriasis are at twice the risk of having a first heart attack at 40-50 years of age.
Those high rates make worse already troubling numbers: 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.
Researchers say continued research will need to be done to confirm whether this is so, or whether the positive effect is a result of treating the underlying inflammatory disease.
Dr. Mehta noted that some patients with severe psoriasis opt not to take a biologic medicine because they suppress the immune system and may increase the chance of infection. In addition, they must be injected.
Previous research has shown that in heart attack patients, anti-inflammatory biologic therapy reduces the risk of another cardiovascular event. “With the results of that study and our current one, my message to patients with psoriasis is to take untreated inflammation seriously,” he said. “When someone has severe psoriasis, they are at higher risk of heart attack and treating the psoriasis may reduce that risk.”
By PPN News Staff
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