Psoriasis is an immune-mediated chronic inflammatory skin disorder that presents with plaques on the skin, and is associated with an increased prevalence of cardiovascular (CV) risk factors and CV disease (CVD).¹Manolis AA et al. Int Rev Immunol. 2019;38(1):33-54. A meta-analysis has found that patients with psoriasis have a higher prevalence of subclinical coronary artery disease (CAD), and more high-risk coronary plaques, compared with control patients without psoriasis.²Kaiser H et al. Dermatol Basel Switz. 2019;235(6):478-487. Psoriasis is often treated with biologic therapy, including anti-TNF, anti-IL/12/23 or anti-IL-17 inhibitors.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. Inflammation is also critical in the progression of CAD.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. Biologic therapies for psoriasis have been associated with an improvement in non-calcified coronary plaque burden.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199.

A recently published study characterised the lipid-rich necrotic core (LRNC) in psoriasis and how LRNC modulates in response to biologic therapy.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. The study utilised a histopathologically validated imaging application on coronary computed tomography angiography (CCTA) images characterising LRNC in the coronary arteries before and after the initiation of biologic therapy in patients over one year.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199.

A total of 209 consecutive biologic-naïve psoriasis patients with baseline and 1-year CCTA scans for analysis were included in this study.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. Biologic therapies for psoriasis included adalimumab, etanercept, ustekinumab, ixekizumab, and secukinumab.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. Patients who chose not to receive biologic therapy at the baseline visit were used as a reference group and were treated with topical, UV, and systemic therapies.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199.

Study participants were middle-aged and predominantly male, with a low cardiovascular risk and mild-to-moderate psoriasis skin disease.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. At 1-year follow-up, patients who had initiated biologic therapy had a decrease in LRNC area (3.12mm² at baseline vs 2.97mm²; p=0.028).³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. In contrast, patients who had not received biologic therapy over the one year demonstrated no significant change in LRNC from baseline.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. The LRNC change over once year between the biologic and non-biologic groups were significant, even after adjustment for psoriasis severity, Framingham risk score, body mass index, and statin use.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199. LRNC reductions continued to be significant compared to the non-biologic patients when stratifying by class of biologic.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199.

This study demonstrated the beneficial effects of biologics on LRNC, although the follow-up period was short, and highlight the potential importance of treating in vivo systemic inflammation to reduce CVD risk in psoriasis.³Choi Harry et al. Circ Cardiovasc Imaging. 2020;13(9):e011199.