Prevalence and extent of subclinical atherosclerosis in patients with psoriasis

Abstract Objective Patients with psoriasis are prone to premature atherosclerosis and increased risk of cardiovascular disease events. However, the prevalence and extent of atherosclerosis in patients with psoriasis are unknown. Design A cross‐sectional study. Setting and subjects The prevalence and extent of coronary and carotid atherosclerosis were compared in 70 patients with psoriasis (46 ± 9 years, 71% male) without known cardiovascular disease or joint involvement and 51 age‐ and gender‐matched healthy control subjects (45 ± 7 years, 71% male). Systemic inflammation was assessed by the level of high‐sensitivity C ‐reactive protein (hs‐ CRP) . Coronary atherosclerosis was determined by the coronary calcification score ( CCS ) measured by multi‐detector computed tomography. Carotid atherosclerosis was assessed by high‐resolution ultrasound‐derived carotid intima–media thickness (c IMT ). Results Patients with psoriasis had a higher prevalence of coronary atherosclerosis ( CCS > 0; 28.6% vs. 3.9%, P < 0.01), and a higher degree of coronary atherosclerosis estimated by the mean CCS (67.4 ± 349.2 vs. 0.5 ± 3.0, P < 0.05) compared with controls. Similarly, c IMT was significantly greater in patients with psoriasis than in control subjects (0.73 ± 0.11 mm vs. 0.67 ± 0.08 mm, P < 0.01). Multiple logistic regression revealed that psoriasis [odd ratio ( OR ): 10.54, 95% confidence interval ( CI ) 1.89–58.67, P < 0.01] and serum total cholesterol level ( OR 2.10, 95% CI 1.01–4.37) were associated with the presence of coronary atherosclerosis ( CCS > 0). By contrast, only age was independently associated with increased c IMT . Amongst participants with no traditional cardiovascular disease risk factors, hs‐ CRP level was higher in patients with psoriasis than in controls. Conclusion The present results demonstrate early‐onset, diffuse arterial atherosclerosis in coronary and carotid arteries in patients with psoriasis, but not in age‐ and gender‐matched control subjects. Low‐grade inflammation could explain the presence of premature atherosclerosis in patients with psoriasis.