Rationale: Psoriasis (PSO) is a systemic inflammatory skin disease associated with cardiovascular disease (CVD) and lipid dysfunction. However, traditional lipid parameters have limited prognostic value whereas assessing oxidation-modified lipids (OMLs) in this inflammatory driven condition may capture additional risk. Recently, a study showed that PSO was associated with increased lipid rich coronary plaques, therefore, investigating potential relationships with OMLs may speed understanding of increased CVD in PSO. Objective: To understand whether OMLs associate with traditional lipid phenotypes, cardiometabolic disease biomarkers and total coronary plaque, with focus on non-calcified burden (NCB) by CCTA in psoriasis. Methods and Results: PSO subjects and controls (n=252) had profiling for oxidation-modified LDL, HDL, Lp(a), cholesterol efflux capacity (CEC), lipoprotein particle size and number by NMR spectroscopy and paraoxonase (PON1) activity. Blinded CCTA coronary artery disease characterization included total burden (TB), NCB and dense-calcified burden (DCB). Compared to healthy volunteers (HV), PSO subjects were older (mean age=50.1), had increased BMI and HOMA-IR. PSO subjects had increase in oxLp(a), Lp(a) and oxHDL (p<0.05 for all) with significant association of oxLDL (β=0.10, p=0.020) and oxHDL (β=−0.11, p=0.007) with NCB. Moreover, PSO subjects expressed significantly higher PON1 (kU/μl) activity compared to HV (8.55 ± 3.21 vs. 6.24 ± 3.82, p=0.01). Finally, PSO treatment was associated with a reduction in oxHDL (U/ml) (203.79 ± 88.40 vs. 116.36 ± 85.03, p<0.001) and with a concomitant decrease in NCB at one year (1.04 ± 0.44 vs. 0.95 ± 0.32, p=0.03). Conclusions: Traditional lipids did not capture risk of lipid rich plaque as assessed by NCB, whereas assaying oxidation-modification of lipids revealed significant association with oxLDL and oxHDL. The PON-1 activity was increased in PSO suggesting possible compensatory anti-oxidative effect. Psoriasis treatment was associated with a reduction in oxHDL. These findings support performance of larger studies to understand oxidation-modified lipids in inflammatory states.

Preclinical and clinical research provide strong evidence that chronic, systemic inflammation plays a key role in development and progression of atherosclerosis. Indeed, chronic inflammatory diseases, such as psoriasis, are associated with accelerated atherosclerosis and increased risk of cardiovascular events. Contemporary research has demonstrated plausible mechanistic links between immune cell dysfunction and cardiometabolic disease in psoriasis. In this review, we describe the role of potential common immunological mechanisms underlying both psoriasis and atherogenesis. We primarily discuss innate and adaptive immune cell subsets and their contributions to psoriatic disease and cardiovascular morbidity. Emerging efforts should focus on understanding the interplay among immune cells, adipose tissue, and various biomarkers of immune dysfunction to provide direction for future targeted therapy.

Background: Women comprise approximately one-third of the advanced heart failure population but may receive fewer advanced heart failure therapies including left ventricular assist devices (LVADs). During the early pulsatile-flow device era, women had higher post-LVAD mortality and increased complications. However, knowledge about these differences in the continuous-flow device era is limited. Therefore, we sought to explore temporal trends in LVAD utilization and post-LVAD mortality by sex. Methods and Results: Patients with LVAD implantation from 2004 to 2016 were identified using the Nationwide Inpatient Sample. Trends in LVAD utilization and post-LVAD inpatient mortality were compared by sex and device era. Although LVADs are being increasingly utilized for patients with advanced systolic heart failure, women continue to represent a smaller proportion of LVAD recipients—25.8% in 2004 to 21.9% in 2016 ( P for trend, 0.91). Women had increased inpatient mortality after LVAD implantation compared with men in the pulsatile-flow era (46.9% versus 31.1%, P <0.0001) but not in the continuous-flow era (13.3% versus 12.1%, P =0.27; P for interaction=0.0002). Inpatient mortality decreased for both sexes over time after LVAD, with a sharp fall in 2008 to 2009. Female sex was independently associated with increased post-LVAD inpatient mortality beyond adjustment for demographics and risk factors during the pulsatile-flow era (odds ratio, 2.13; 95% CI, 1.45–3.10; P <0.0001) but not during the continuous-flow era (1.18; 0.93–1.48; P =0.16). Conclusions: Although utilization of LVAD therapy increased over time for both sexes, LVAD implantation remains stably lower in women, which may suggest a potential underutilization of this potentially life-saving therapy. Prospective studies are needed to confirm these findings.