Cholesterol efflux capacity is associated with lipoprotein size and vascular health in mild to moderate psoriasis

Background and objective Psoriasis is a systemic inflammatory condition with poor cholesterol transport measured by cholesterol efflux capacity (CEC) that is associated with a heightened risk of cardiovascular disease (CVD). In psoriasis patients, we sought to characterize the lipoprotein profile by size using a novel nuclear magnetic resonance algorithm in patients with low CEC compared to normal CEC. Methods Lipoprotein profile was assessed using the novel nuclear magnetic resonance LipoProfile-4 deconvolution algorithm. Aortic vascular inflammation (VI) and non-calcified burden (NCB) were characterized via positron emission tomography-computed tomography and coronary computed tomography angiography. To understand the relationship between lipoprotein size and markers of subclinical atherosclerosis, linear regression models controlling for confounders were constructed. Results Psoriasis patients with low CEC had higher more severe psoriasis ( p = 0.04), VI ( p = 0.04) and NCB ( p = 0.001), concomitant with smaller high-density lipoprotein (HDL) ( p < 0.001) and low-density lipoprotein (LDL) particles ( p < 0.001). In adjusted models HDL size ( β = −0.19; p = 0.02) and LDL size ( β = −0.31; p < 0.001) associated with VI and NCB. Lastly, HDL size strongly associated with LDL size in fully adjusted models ( β = −0.27; p < 0.001). Conclusion These findings demonstrate that in psoriasis, low CEC associates with a lipoprotein profile comprised of smaller HDL and LDL particles which correlates with vascular health and may be driving early onset atherogenesis. Further, these results demonstrate a relationship between HDL and LDL size and provide novel insights into the complexities of HDL and LDL as biomarkers of vascular health.