Systemic inflammation may play role in association between skin disease severity and CVD in psoriasis: JAMA

The study, published in JAMA Dermatology, revealed that psoriasis severity, measured by the Psoriasis Area and Severity Index (PASI), was linked to systemic inflammation. Additionally, PASI and systemic inflammation, assessed through GlycA levels, were connected to CVD, with systemic inflammation potentially mediating the relationship between PASI and CVD.

Psoriasis is linked to an elevated risk of cardiovascular disease, though the precise mechanisms driving this connection remain uncertain. Understanding these pathways could aid in developing targeted treatments and provide insight into how peripheral inflammation, like psoriatic skin lesions, contributes to CVD. With this in mind, Axel Svedbom, Dermatology and Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden, and colleagues aimed to investigate whether systemic inflammation mediates the relationship between psoriasis severity and CVD.

For this purpose, the researchers analyzed data from two cohorts: the PACI (2013–2022) in Maryland and the SPC (2000–2005) in Sweden. PACI included patients with prevalent psoriasis referred by dermatologists, while SPC included incident psoriasis cases from various practices. Psoriasis severity was assessed using PASI, and systemic inflammation was measured via GlycA, a glycan biomarker of acute-phase proteins.

Mediation analysis examined associations between PASI, systemic inflammation, and outcomes like noncalcified coronary burden (NCB) and cardiovascular events. Data analysis from October 2023 to January 2024 explored how systemic inflammation might mediate the link between psoriasis severity and cardiovascular risk.

Based on the study, the researchers reported the following findings:

• Of 260 eligible patients in the PACI cohort, 62.3% were male, with a median age of 51.
• Of 509 eligible patients in the SPC cohort, 46.6% were male, with a median age of 43.
• PASI was associated with GlycA levels and cardiovascular disease in both studies.
• GlycA levels were independently associated with CVD.
• The direct effect of PASI on noncalcified coronary burden (NCB) was 0.94.
• The indirect effect of PASI on NCB via GlycA was 0.19.
• The odds ratio for the direct effect of PASI on cardiovascular events was 1.23.
• The odds ratio for the indirect effect of PASI on cardiovascular events via GlycA was 1.16.

"The findings indicate that systemic inflammation, assessed through GlycA levels, may mediate the relationship between psoriasis severity, measured by PASI scores, and cardiovascular disease in individuals with psoriasis. Further research could investigate whether managing skin disease severity helps reduce subclinical atherosclerosis and the risk of cardiovascular events," the researchers concluded.

Reference:

Svedbom A, Mallbris L, González-Cantero Á, et al. Skin Inflammation, Systemic Inflammation, and Cardiovascular Disease in Psoriasis. JAMA Dermatol. Published online November 20, 2024. doi:10.1001/jamadermatol.2024.4433