Aortic vascular inflammation, detected by F18 positron emission tomography/CT (18F-FDG PET/CT), was linked with coronary artery disease (CAD) based on coronary CT angiography (CCTA) among psoriasis patients in a cross-sectional cohort study.
Among 215 such patients, those with increased aortic vascular inflammation (VI) had increased total plaque buildup (TB; standardized β=0.48; P<0.001), higher prevalence of luminal stenosis (OR 3.63, P=0.001), and high-risk plaques (HRP; OR 3.05, P=0.004), reported Nehal Mehta, MD, of National Institute of Heath, Heart, Lung, and Blood Institute in Bethesda, Maryland, and colleagues in JAMA Cardiology.
Among the key findings: "when stratified by high aortic VI, the extent of CAD is greater in those with elevated aortic VI, in line with greater quantitative total CAD burden, increased prevalence of luminal stenoses, more severe luminal stenosis, and a higher prevalence of HRP" as well as "the increase in TB is predominantly driven by [noncalcified coronary plaque burden] NCB, whereas dense-calcified burden does not differ by varying degrees of aortic VI," the researchers wrote.
Moreover, Mehta and peers also noted a "strong association between aortic VI by 18F-FDG PET/CT and CAD indices derived from CCTA in unadjusted analyses and beyond adjustment for traditional cardiovascular risk factors."
These direct associations go beyond traditional cardiovascular risk factors, highlighted Jagat Narule, MD, PhD, and Eloisa Arbustini, MD, both of Icahn School of Medicine at Mount Sinai in New York City, in an accompanying editorial.
"The study leads to a hypothesis that aortic vascular inflammation might serve as a surrogate marker for high-risk CAD," the editorialists wrote.
"No cause and effect was shown, however a very powerful association has now been demonstrated," emphasized Kevin Campbell, MD, of Wake Heart and Vascular Associates in Raleigh, North Carolina, in an interview with MedPage Today regarding the study, to which he did not contribute.
"This association may lead us to examine other patients with inflammatory disease states and look to diagnose potential coronary artery disease earlier -- leading to earlier intervention and likely prevention of the devastating consequences of CAD and vascular such as heart attack and stroke," Campbell further noted.
The researchers evaluated 215 psoriasis patients (average age 50.4 years old, 59% male) from dermatology practices near the NIH in Maryland. All the patients were assessed using the 18F-FDG PET/CT, while 190 patients underwent coronary computed tomography angiography to identify coronary artery disease.
The findings indicated an association between aortic VI and TB primarily driven by NCB (β=0.49; P<0.001), while on the other hand, the link between aortic VI and HRP was driven by low-attenuation plaque (OR, 5.63; 95% CI, 1.96-16.19; P=0.001).
Moreover, the associations for aortic VI were significant even after being adjusted for cardiovascular risk factors: aortic VI and TB (β=0.23; P<0.001), NCB (β=0.24; P<0.001), luminal stenosis (OR, 3.40; 95% CI, 1.40-8.24; P=0.007), and HRP (OR, 2.72; 95% CI, 1.08-6.83; P=0.03).
The immune system and inflammation play a critical role in the development of heart disease, commented Campbell. "Studies such as this one provide us with more evidence and may provide us with another diagnostic tool. It is critical to diagnose CAD early and intervene before there is a heart attack -- our medical system focuses too much on treatment -- prevention is where the real savings lies -- both in healthcare dollars and in patient lives -- and this study provides another tool for identifying those at risk," Campbell elaborated.
The researchers adjusted for body mass index within the multivariable model and still found significant outcomes. "When imaging targets of small size, such as atherosclerotic plaques,the spatial resolution limitations of PET imaging create a close association between lesion size and the apparent lesion intensity," the investigators wrote.
"Thus, an interaction is possible between apparent plaque size measured by CT and standardized tracer activity of the aorta,considering that larger individuals will have larger coronary arteries and aortic wall sizes," they continued.
Looking ahead, the investigators noted, "larger prospective studies need to assess these associations longitudinally and examine treatment effects on these outcomes."
The study was supported by National Heart, Lung, and Blood Institute Intramural Research Program.
Mehta disclosed relationships with the US government, National Heart, Lung, and Blood Institute from AbbVie, Janssen, Celgene, and Novartis.
Campbell disclosed relationships with PaceMate.
Read the original article on Medpage Today: Aortic Vascular Inflammation Associated With CAD in Psoriasis