Abstract 16756: Quantitative Coronary CT Angiography Demonstrates Increased Total Burden and Non-Calcified Plaque in Psoriasis

Abstract

Introduction: Coronary computed tomography angiography (CCTA) directly characterizes composition of plaque in coronary heart disease (CHD). Although the use of CCTA has been established in clinical CHD, no study to date has ever examined how psoriasis (PSO), a chronic inflammatory skin disease associated with increased risk for myocardial infarction (MI), affects CHD by CCTA. Therefore, our goal was to understand whether psoriasis increases CHD detected by CCTA and establishes CHD plaque characteristics compared to subjects with clinical coronary disease and healthy volunteers. Methods: Subjects with PSO (N=54), CHD (N=75) and healthy controls (N=5) underwent quantitative coronary CCTA imaging (Toshiba MDCT). Total coronary plaque was assessed using QAngioCT (Medis, Netherlands) as the total coronary artery wall volume. Furthermore, to better understand the determinants of CHD [total burden (TB) and non-calcified plaque burden (NCB)], we performed deep phenotyping for lipid markers including lipid particle size and numbers, HDL efflux, and metabolic parameters of insulin resistance such as Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) in psoriasis. Results: Our study showed that PSO was associated with higher TB and NCB of CHD when compared to both CHD and control groups (See Table 1). These findings were robust to adjustment for CHD risk factors (Framingham risk score) and luminal density (TB β=7.6, p<0.001 & NCB β=5.1, p=0.001). NCB was strongly associated with BMI (β=0.38, p<0.01), HDL efflux capacity (β=-10.9, p<0.05) and insulin resistance estimated by HOMA-IR (β=0.53, p<0.05) in psoriasis. Conclusions: This is the first study to show that psoriasis increases total burden of CHD which is non-calcified providing compelling evidence for the association between psoriasis and MI. Determinants of this NCB suggest focusing therapies on lipid and metabolic derangement in psoriasis may reduce this risk of future events.