Study: Biologic Therapy for Psoriasis May Reduce Heart Disease

Patients with psoriasis treated with biologic therapy, which are protein-based infusions to suppress inflammation, had a significant reduction in high-risk plaque in heart arteries over 1 year, according to new research published in Circulation: Cardiovascular Imaging, an American Heart Association journal.

Chronic inflammation in people with psoriasis is associated with a higher risk of developing coronary artery disease. Further, biologic therapy medications are proteins that are given by injection or infusion and suppress the inflammation process by blocking the action of cytokines, which are proteins that promote systemic inflammation, according to the study authors.

Previous research has shown a clear link between psoriasis and the development of high-risk coronary plaque. However, the current study provides characterization of a lipid-rich necrotic core, a dangerous type of coronary plaque made up of dead cells and cell debris that is prone to rupture, which can lead to a heart attack or stroke.

“Having inflamed plaque that is prone to rupture increases the risk of heart attack five-fold within 10 years,” said study senior author Nehal N. Mehta, MD, MSCE, FAHA, in a press release.

The analysis involved 209 middle-aged patients, between 37 and 62 years of age, with psoriasis and who participated in the Psoriasis Atherosclerosis Cardiometabolic Initiative at the National Institutes of Health. Of these participants, 124 patients received biologic therapy and 85 patients in the control group were treated only with topical creams and light therapy, according to the study authors.

The researchers performed cardiac computed tomography scans on all study participants before they started therapy and 1 year later to measure the effects of biologic therapy on arteries of the heart.

At the start of the study, participants with psoriasis had low cardiovascular risk by conventional cardiovascular risk scores. Severe psoriasis was associated with higher body mass index, high-sensitivity C-reactive protein, and higher levels of coronary artery plaque.

After 1 year of treatment, patients who received biologic therapy were compared with the control group. Researchers found biologic therapy was associated with an 8% reduction in coronary plaque. In contrast, those in the control group experienced slightly increased coronary plaque progression, according to the study authors.

Even after adjusting for cardiovascular risk factors and psoriasis severity, patients treated with biologic therapy had reduced coronary plaque.

“There is approximately 6%-8% reduction in coronary plaque following therapy with statins,” Mehta said in a press release. “Similarly, our treatment with biologic therapy reduced coronary plaque by the same amount after one year. These findings suggest that biologic therapy to treat psoriasis may be just as beneficial as statin therapy on heart arteries.”

The study did have implications for people with psoriasis and possibly for those with other chronic inflammatory conditions, such as HIV, lupus, and rheumatoid arthritis, who also have increased risk of heart disease, according to the authors.

“We have never before been able to show healing of an inflamed plaque like this in humans. Biologic therapy reduces systemic inflammation and immune activation, and it has a favorable impact on improving overall vascular health,” Mehta said in a press release. “Imagine if we can treat both psoriasis and coronary heart disease with one therapy—that is the question to be asked in future studies.”

The findings of the study should be interpreted with caution because it was limited by a short follow-up period and a relatively small number of patients, according to the authors. Future studies should involve larger, randomized controlled studies to better understand how changes in coronary plaque may lead to a reduction in heart attacks and strokes in people with psoriasis, according to the study authors.

REFERENCE

Biologic therapy for psoriasis may reduce heart disease. American Heart Association. https://newsroom.heart.org/news/biologic-therapy-for-psoriasis-may-reduce-heart-disease#:~:text=DALLAS%2C%20September%2015%2C%202020%20%E2%80%94,Circulation%3A%20Cardiovascular%20Imaging%2C%20an%20American. Published September 15, 2020. Accessed January 7, 2021.