The Heart-Healthy Benefits of Psoriasis Treatment

Treating psoriasis may do more than clear up your skin; it could also protect your heart. Psoriasis, often seen as just a skin condition with red, scaly patches, is linked to deeper health issues. The chronic inflammation caused by psoriasis is not simply a dermatologic concern; it can affect other aspects of physiology, including increasing your risk of heart disease.

In 2020, a prospective observational study published in Circulation: Cardiovascular Imaging found that treating psoriasis with biologic therapy, a medication that targets inflammation, reduced harmful plaque buildup in heart arteries. This suggests that managing psoriasis improves skin health and lowers the risk of heart disease for people with inflammatory conditions.

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The Study: Objectives And Methodology

The study aimed to see if biologic therapy, used to reduce inflammation in psoriasis, could also lower heart disease risk by reducing a dangerous type of arterial plaque called lipid-rich necrotic core (LRNC). LRNC is prone to rupture, much like a weak spot in a dam, and can lead to heart attacks or strokes. Since inflammation plays an integral role in developing such plaques, the researchers wanted to determine if treating psoriasis-related inflammation could benefit heart health.

The study cohort, which included 209 psoriasis patients aged 37 to 62, was split into two groups. One group, 124, received biologic therapy, while the other 85 received topical treatments such as creams and light therapy. Participants were selected based on moderate cardiovascular risk, meaning they had no immediate heart disease but were at higher risk due to chronic inflammation from psoriasis.

Researchers used coronary computed tomography angiography (CCTA), a non-invasive imaging technique providing detailed views of the coronary arteries. This was paired with advanced imaging software, vascuCAP, to track changes in LRNC. Baseline scans were done at the start, and follow-up scans one year later assessed if biologic therapy had reduced the dangerous plaque.

The study's use of CCTA and advanced software focused on the plaque's composition, not just artery blockages. This approach provided detailed insights into how biologic therapy could impact heart health. The study showed that biologic therapy effectively reduced heart plaque and possibly heart disease risk by adjusting for cardiovascular risk factors like cholesterol and body mass index (BMI).

The Findings of the Study

Patients treated with biologic therapy experienced an 8% reduction in lipid-rich necrotic core (LRNC), the high-risk plaque in the coronary arteries that is prone to rupture and cause heart attacks. In contrast, participants who did not receive biologic therapy showed no significant change in the size or composition of their LRNC plaque.

Even after accounting for other cardiovascular risk factors, such as cholesterol levels and body mass index (BMI), the reduction in LRNC remained significant in the biological therapy group. This reduction in plaque was consistent across various biologic therapies, including anti-tumor necrosis factor (anti-TNF), anti-interleukin-12/23 (anti-IL 12/23), and anti-interleukin-17 (anti-IL 17) treatments.

Traditional treatments like creams and light therapy did not impact plaque levels, highlighting that biologic therapy directly targets and reduces inflammation-driven plaque. The biologic therapy group also showed no progression in other types of coronary artery plaque, suggesting a potential stabilizing effect on heart health.

Significance of the Findings

The findings highlight that controlling inflammation, whether in the skin (from psoriasis) or within the arteries, can significantly lower the risk of heart-related complications like heart attacks and strokes.

The study demonstrates that biologic therapy not only treats psoriasis but also actively reduces harmful plaque in the heart's arteries, providing direct cardiovascular benefits. By reducing lipid-rich necrotic core (LRNC), a high-risk plaque type prone to rupture, biologic therapy may decrease the risk of heart attacks in individuals with chronic inflammation.

The research offers another example of how inflammation, a central factor in many diseases, can be reversed, not just managed. This provides new strategies to reduce cardiovascular risk in psoriasis patients. These results extend beyond psoriasis, suggesting that biologic therapy could benefit people with other inflammatory conditions like rheumatoid arthritis and lupus, which are also linked to increased heart disease risk.

The study reinforces the idea that systemic inflammation plays a central role in cardiovascular health, supporting the use of anti-inflammatory treatments to prevent heart disease in at-risk populations. The findings pave the way for future research to explore the potential heart-protective effects of biologic therapies in a broader range of inflammatory disorders.

Limitations of the Study

The study's limitations include its short one-year follow-up period, which makes it unclear if the reduction in harmful plaque will last over time or lead to a long-term decrease in heart attacks. Further research with longer follow-up is needed to confirm the sustained benefits of biologic therapy on heart health.

Additionally, the relatively small sample size of 209 participants limits the generalizability of the findings. Larger studies with more diverse populations are necessary to validate the results and ensure they apply to a broader range of individuals with different demographics and health conditions.

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Key Takeaways

• The study shows that biologic therapy for psoriasis treats the skin condition and helps reduce dangerous heart plaque, lowering the risk of heart disease in those with chronic inflammation. 

• This dual benefit of biologic therapy could offer a more comprehensive treatment approach for patients with psoriasis and an elevated risk of cardiovascular problems.  

• To fully understand the therapy's long-term cardiovascular effects, more research involving larger and more diverse populations and longer follow-up periods is required.