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Original Investigation
September 12, 2018

Association Between Aortic Vascular Inflammation and Coronary Artery Plaque Characteristics in Psoriasis

Author Affiliations
  • 1National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  • 2Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison
  • 3Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Research Center, Bethesda, Maryland
  • 4Department of Dermatology, University of Pennsylvania, Philadelphia
  • 5The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
JAMA Cardiol. Published online September 12, 2018. doi:10.1001/jamacardio.2018.2769
Key Points

Question  What is the association between aortic vascular inflammation by fludeoxyglucose F 18 (18F-FDG) positron emission tomography/computed tomography and coronary artery disease by coronary computed tomography angiography?

Findings  In this cross-sectional cohort study of 215 patients with psoriasis assessed with 18F-FDG positron emission tomography/computed tomography and coronary computed tomography angiography, aortic vascular inflammation was directly associated with quantitative burden of coronary artery disease, luminal stenosis severity within the coronary arteries, and the prevalence of high-risk coronary plaque beyond traditional cardiovascular risk factors.

Meaning  Aortic vascular inflammation by 18F-FDG positron emission tomography/computed tomography is associated with presence of coronary artery disease by coronary computed tomography angiography, suggesting that 18F-FDG PET/CT may provide a potential surrogate of early coronary artery disease.

Abstract

Importance  Inflammation is critical to atherosclerosis. Psoriasis, a chronic inflammatory disease associated with early cardiovascular events and increased aortic vascular inflammation (VI), provides a model to study the process of early atherogenesis. Fludeoxyglucose F 18 positron emission tomography/computed tomography (18F-FDG PET/CT) helps quantify aortic VI, and coronary computed tomography angiography provides coronary artery disease (CAD) assessment through evaluation of total plaque burden (TB) and noncalcified coronary plaque burden (NCB), luminal stenosis, and high-risk plaques (HRP). To our knowledge, association between aortic VI and broad CAD indices has not yet been assessed in a chronic inflammatory disease state. Such a study may provide information regarding the utility of aortic VI in capturing early CAD.

Objective  To assess the association between aortic VI and CAD indices, including TB, NCB, luminal stenosis, and HRP prevalence, in psoriasis.

Design, Setting, and Participants  In a cross-sectional cohort study at the National Institutes of Health, 215 consecutive patients with psoriasis were recruited from surrounding outpatient dermatology practices. All patients underwent 18F-FDG PET/CT for aortic VI assessment, and 190 of 215 patients underwent coronary computed tomography angiography to characterize CAD. The study was conducted between January 1, 2013, and May 31, 2017. Data were analyzed in March 2018.

Exposures  Aortic VI assessed by 18F-FDG PET/CT.

Main Outcomes and Measures  Primary outcome: TB and NCB. Secondary outcomes: luminal stenosis and HRP.

Results  Among 215 patients with psoriasis (mean [SD] age, 50.4 [12.6] years; 126 men [59%]), patients with increased aortic VI had increased TB (standardized β = 0.48; P < .001), and higher prevalence of luminal stenosis (OR, 3.63; 95% CI, 1.71-7.70; P = .001) and HRP (OR, 3.05; 95% CI, 1.42-6.47; P = .004). The aortic VI and TB association was primarily driven by NCB (β = 0.49; P < .001), whereas the aortic VI and HRP association was driven by low-attenuation plaque (OR, 5.63; 95% CI, 1.96-16.19; P = .001). All associations of aortic VI remained significant after adjustment for cardiovascular risk factors: aortic VI and TB (β = 0.23; P < .001), NCB (β = 0.24; P < .001), luminal stenosis (OR, 3.40; 95% CI, 1.40-8.24; P = .007), and HRP (OR, 2.72; 95% CI, 1.08-6.83; P = .03). No association was found between aortic VI and dense-calcified coronary plaque burden.

Conclusions and Relevance  Aortic VI is associated with broad CAD indices, suggesting that aortic VI may be a surrogate for early CAD. Larger prospective studies need to assess these associations longitudinally and examine treatment effects on these outcomes.

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