Elsevier

The American Journal of Medicine

Volume 128, Issue 12, December 2015, Pages 1325-1334.e2
The American Journal of Medicine

Clinical research study
Increased Prevalence of Coronary Artery Disease in Severe Psoriasis and Severe Atopic Dermatitis

https://doi.org/10.1016/j.amjmed.2015.05.041Get rights and content

Abstract

Background

Psoriasis and atopic dermatitis (AD) are immuno-inflammatory diseases that can result in lifelong systemic inflammation. Unlike AD, psoriasis has been associated with cardiovascular disease. The aim of this study was to examine the prevalence, severity, and subtype of coronary artery disease (CAD) in psoriasis and AD patients without known cardiovascular disease.

Methods

Consecutively enrolled patients (psoriasis n = 58, AD n = 31) and retrospectively matched controls (n = 33) were examined using cardiac computed tomography angiography (CCTA) and assessed using an 18-segment model of the coronary tree.

Results

The prevalence of a coronary artery calcium score >0 was 29.8% in psoriasis and 45.2% in AD, vs 15.2% in controls (P = .09 and P = .01, respectively). More patients with psoriasis had a coronary artery calcium score ≥100 (psoriasis 19.3%, controls 2.9%; P = .02). CCTA showed the presence of plaques in 38.2% of psoriasis patients and 48.1% of AD patients, vs 21.2% of controls (P = .08 and P = .03, respectively). Psoriasis was associated with an increased prevalence of significant coronary stenosis (stenosis >70%) (psoriasis 14.6%, controls 0%; P = .02) and 3-vessel coronary affection or left main artery disease (psoriasis 20%, controls 3%; P = .02), whereas AD was associated with mild (AD 40.7%, controls 9.1%; P = .005) single-vessel affection.

Conclusions

These findings suggest that psoriasis and AD are associated with an increased prevalence of CAD. Patients with psoriasis have an increased prevalence of severe CAD.

Section snippets

Study Design

The clinical study was conducted as a single-center observational case-control study. The Central Denmark Region Committees on Biomedical Research Ethics and the Danish Data Protection Agency approved the study protocol before patient enrollment commenced. All prospectively enrolled participants provided written informed consent before entering the study. The Committee on Research Ethics waived the requirement for informed consent regarding the retrospectively matched control group. This trial

Patient Characteristics

A total of 84 psoriasis patients were considered for enrollment. Five were excluded due to prior cardiovascular events or prior coronary interventions. Nineteen patients were excluded for other reasons (eg, low disease activity, concurrent diseases, personal reasons). Within atopic dermatitis patients, 46 subjects were considered for enrollment. One was excluded due to cardiovascular disease. Ten patients were excluded for other reasons. A total of 60 psoriasis and 35 atopic dermatitis patients

Discussion

While our pooled data on segment analysis confirm an increased prevalence of coronary artery disease in severe psoriasis, the most important finding in our study was obtained using cardiac CT beyond coronary artery calcium scoring. These findings showed that the prevalence of severe coronary artery disease was increased despite the absence of symptoms or a history of cardiovascular disease in patients with psoriasis. More patients than controls suffered from elevated calcium scores, multiple

Acknowledgment

The authors thank the staff at the Cardiac Imaging Centre, Department of Cardiology, Aarhus University Hospital, Denmark, for their contribution.

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    • Cited by (0)

    Funding: This study was supported by a grant from AbbVie (Grant number IMM-10-0165). AbbVie had no influence on the design of the study or interpretation of the results. Furthermore, the study was supported by nonrestricted research grants from the Central Denmark Region Research Foundation and the Hofbuntmager Aage Bang Foundation.

    Conflict of Interest: None.

    Authorship: Drs. KFH and MB had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: KFH, MB, CV, MD, LI, KK. Acquisition of data: KFH, CV, LR, MD. Analysis and interpretation of data: All. Drafting of the manuscript: All. Critical revision of the manuscript for important intellectual content: All. Statistical analysis: KFH, MB. Obtained funding: KFH, KK.

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