Session Type: Abstract Submissions (ACR)
The pathophysiologic mechanisms underlying the accelerated atherosclerosis in patients with psoriatic disease (PsD) are unknown. We aimed to investigate candidate pathways involved in this process by identifying biomarkers that predicted progression of atherosclerotic plaques in patients with PsD.
A prospective cohort study was conducted in patients with psoriatic arthritis (PsA) and psoriasis alone (PsC) from 2010 to 2014. Patients with PsA met the CASPAR criteria. Patients with PsC were examined by a rheumatologist to exclude the presence of arthritis. Information about demographics, co-morbidities and disease manifestations was collected. The following serum cardiovascular and metabolic biomarkers were assessed at baseline by enzyme-linked immunosorbent assay (ELISA): insulin, adiponectin, leptin, vascular cell adhesion molecule 1 (VCAM-1), intracellular adhesion molecule 1 (ICAM-1), plasminogen activator inhibitor 1 (PAI-1), myeloperoxidase (MPO) and lipoprotein-associated phospholipase A2 (Lp-PLA2). The homeostatic model assessment (HOMA) was calculated using insulin and glucose levels to estimate insulin resistance. Ultrasound assessment of the carotid arteries was performed and Total Plaque Area (TPA) was measured at baseline and after 3 years. This measure represented the extent of atherosclerosis and was considered the outcome of interest. TPA at baseline was classified to 4 categories (No plaques, mild, moderate and severe atherosclerosis). A significant progression in atherosclerosis was defined as an increase in TPA of > 0.1 cm2 at 3 years (top quartile of TPA progression from baseline). The association between the log-transformed levels of the various biomarkers and TPA at baseline and atherosclerosis progression at 3 years was assessed using logistic regression models adjusted for age, sex and cardiovascular risk factors.
A total of 235 patients with PsD (121 PsA, 114 PsC) were scanned at baseline, 129 of them were re-scanned at 3 years. The mean age of the study population was 52.5±11.9 years and 54% were males. Patients with more severe atherosclerosis at baseline had higher levels of VCAM-1 (p=0.0002), ICAM-1 (p=0.03), leptin (p=0.03) and HOMA (p=0.0002), however in the age- and sex-adjusted model only HOMA remained significantly associated with more severe atherosclerosis (Odds Ratio (OR) 1.6, 95% Confidence Interval (CI) 1.2, 2.3, p=0.006). 31 of 129 patients had a significant progression of atherosclerosis at 3 years. Higher levels of Lp-PLA2 (p=0.03), PAI-1 (p=0.05) and HOMA (p=0.01) and lower levels of adiponectin (p=0.04) predicted progression of atherosclerosis. In the multivariate regression model adjusted for age, sex and cardiovascular risk factors, Lp-PLA2 (OR 5.5, 95% CI 1.4, 22.5, p=0.02), adiponectin (OR 0.3, 95% CI 0.1, 0.8, p=0.008) and HOMA (OR 2.2, 95% CI 1.1, 4.4, p=0.03) predicted progression of atherosclerosis in patients with PsD. No interaction was found between disease status (PsA vs. PsC) and any of the biomarkers.
Biomarkers involved in lipid and glucose metabolism and other metabolic pathways play a role in progression of atherosclerosis in patients with PsD.
D. D. Gladman,
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-predictive-value-of-cardiovascular-and-metabolic-biomarkers-for-progression-of-atherosclerosis-in-psoriatic-disease/