Metabolic syndrome and its factors are associated with noncalcified coronary burden in psoriasis: An observational cohort study - 03/02/21

Doi : 10.1016/j.jaad.2020.12.044

Meron Teklu, BA ^a, Wunan Zhou, MD, MPH ^a, Promita Kapoor, CCRP ^a, Nidhi Patel, BS ^a, Amit K. Dey, MD ^a, Alexander V. Sorokin, MD, PhD ^a, Grigory A. Manyak, BA ^a, Heather L. Teague, PhD ^a, Julie A. Erb-Alvarez, MPH ^a, Aparna Sajja, MD ^b, Khaled M. Abdelrahman, BS ^a, Aarthi S. Reddy, BS ^a, Domingo E. Uceda, BS ^a, Sundus S. Lateef, BS ^a, Sujata M. Shanbhag, MD ^a, Colin Scott, BS ^a, Nina Prakash ^a, Maryia Svirydava, BS ^a, Philip Parel ^a, Justin A. Rodante, PA-C ^a, Andrew Keel, CRNP ^a, Evan L. Siegel, MD ^c, Marcus Y. Chen, MD ^a, David A. Bluemke, MD, PhD ^d, Martin P. Playford, PhD ^a, Joel M. Gelfand, MD, MSCE ^e,^f, Nehal N. Mehta, MD, MSCE, FAHA ^a,^⁎
^a National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
^b Department of Internal Medicine, Johns Hopkins University Medical Center, Baltimore, Maryland
^c Department of Rheumatology, Arthritis and Rheumatism Associates, Rockville, Maryland
^d Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
^e Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania
^f Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, Pennsylvania

^∗Correspondence to: Nehal N. Mehta, MD, MSCE, FAHA, Lasker Senior Investigator, Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Clinical Research Center, Room 5-5140, Bethesda, MD 20892.Lasker Senior InvestigatorSection of Inflammation and Cardiometabolic DiseasesNational Heart, Lung, and Blood InstituteNational Institutes of Health10 Center Dr, Clinical Research Center, Room 5-5140BethesdaMD20892

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Abstract

Background

Psoriasis is associated with a heightened risk of cardiovascular disease and higher prevalence of metabolic syndrome.

Objective

Investigate the effect of metabolic syndrome and its factors on early coronary artery disease assessed as noncalcified coronary burden by coronary computed tomography angiography in psoriasis.

Methods

This cross-sectional study consisted of 260 participants with psoriasis and coronary computed tomography angiography characterization. Metabolic syndrome was defined according to the harmonized International Diabetes Federation criteria.

Results

Of the 260 participants, 80 had metabolic syndrome (31%). The metabolic syndrome group had a higher burden of cardiometabolic disease, systemic inflammation, noncalcified coronary burden, and high-risk coronary plaque. After adjusting for Framingham risk score, lipid-lowering therapy, and biologic use, metabolic syndrome (β = .31; P < .001) and its individual factors of waist circumference (β = .33; P < .001), triglyceride levels (β = .17; P = .005), blood pressure (β = .18; P = .005), and fasting glucose (β = .17; P = .009) were significantly associated with noncalcified coronary burden. After adjusting for all other metabolic syndrome factors, blood pressure and waist circumference remained significantly associated with noncalcified coronary burden.

Limitations

Observational nature with limited ability to control for confounders.

Conclusions

In psoriasis, individuals with metabolic syndrome had more cardiovascular disease risk factors, systemic inflammation, and noncalcified coronary burden. Efforts to increase metabolic syndrome awareness in psoriasis should be undertaken to reduce the heightened cardiovascular disease risk.

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Key words : atherosclerosis, cardiovascular disease, hypertension, metabolic syndrome, obesity, preventive medicine, psoriasis

Abbreviations used : GlycA, IQR, SD

Plan

Introduction

Methods

Study participants

Metabolic syndrome definition

Clinical and laboratory measurements

Coronary burden characterization by coronary computed tomography angiography

Visceral and subcutaneous adipose tissue quantification

Statistical analysis

Results

Characteristics of the study group

Characteristics of the study group stratified by metabolic syndrome status

Association between metabolic syndrome, its factors, and noncalcified coronary burden

Association between metabolic syndrome, its factors, and total, subcutaneous, and visceral adipose tissue volumes

Discussion

	Funding sources: Supported by the National Heart, Lung, and Blood Institute Intramural Research Program (HL006193-07).
	IRB approval status: Reviewed and approved by the institutional review board of the National Institutes of Health (approval 13H-0065).