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Original Investigation |

Comparison of Coronary Artery Calcium Scores Between Patients With Psoriasis and Type 2 Diabetes ONLINE FIRST

Bobbak Mansouri, MD1,2; Dario Kivelevitch, MD1,3; Balaji Natarajan, MD4,5; Aditya A. Joshi, MD5; Caitriona Ryan, MD1; Katie Benjegerdes, BS6; Jeffrey M. Schussler, MD7,8,9; Daniel J. Rader, MD10; Muredach P. Reilly, MBBCH, MSCE10,11,12; Alan Menter, MD1; Nehal N. Mehta, MD, MSCE5
[+] Author Affiliations
1Division of Dermatology, Baylor University Medical Center, Dallas, Texas
2Department of Dermatology, Baylor Scott and White Health, Temple, Texas
3Baylor Institute for Immunology Research, Dallas, Texas
4University of Arizona College of Medicine at South Campus, Tucson
5National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
6Texas A&M Health Science Center College of Medicine, Temple
7Division of Cardiology, Baylor University Medical Center, Dallas, Texas
8Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
9Texas A&M Health Science Center College of Medicine, Dallas
10Perelman School of Medicine, University of Pennsylvania, Philadelphia
11Division of Cardiology, Department of Medicine, Columbia University, New York, New York
12Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
JAMA Dermatol. Published online August 24, 2016. doi:10.1001/jamadermatol.2016.2907
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Importance  Psoriasis is associated with an increased risk of cardiovascular diseases. Subclinical atherosclerosis in patients with psoriasis has not been compared with other conditions associated with increased cardiovascular risk and more rigorous cardiovascular disease screening, such as type 2 diabetes.

Objective  To assess the burden of asymptomatic coronary atherosclerosis measured by coronary artery calcium score in patients with moderate to severe psoriasis compared with patients with type 2 diabetes and healthy controls.

Design, Setting, and Participants  Three single-center, cross-sectional studies were performed in patients recruited from specialty outpatient clinics with moderate to severe psoriasis without type 2 diabetes (recruited from November 1, 2013, through April 31, 2015), patients with type 2 diabetes without psoriasis or other inflammatory diseases (recruited from July 1, 2009, through June 20, 2011), and age- and sex-matched healthy controls without psoriasis, type 2 diabetes, or other inflammatory diseases (recruited from July 1, 2009, through June 20, 2011).

Exposures  Psoriasis, type 2 diabetes, and healthy control effect on coronary artery calcium score.

Main Outcomes and Measures  Coronary artery calcium measured by Agatston score.

Results  A total of 387 individuals participated in the study. Mean (SD) age was 51 (7.7), 52 (8.0), and 52 (8.0) years in the psoriasis, type 2 diabetes, and healthy control cohorts, respectively. There were 64 men (49.6%) in each group, and most patients were white (119 [92.2%], 123 [95.3%], and 128 [99.2%] in the psoriasis, type 2 diabetes, and healthy control cohorts, respectively). Patients with psoriasis had low cardiovascular risk measured by the Framingham Risk Score but had a high prevalence of cardiovascular and cardiometabolic risk factors, similar to patients with type 2 diabetes. In a fully adjusted model, psoriasis was associated with coronary artery calcium (Tobit regression ratio, 0.89; P < .001) similar to the association in type 2 diabetes (Tobit regression ratio, 0.79; P = .04). Likelihood ratio testing revealed incremental value for psoriasis in a fully adjusted model (χ2 = 4.48, P = .03) in predicting coronary artery calcium. Psoriasis was independently associated with the presence of any coronary artery calcium (odds ratio, 2.35; 95% CI, 1.12-4.94) in fully adjusted models, whereas the association of coronary artery calcium with type 2 diabetes was no longer significant after adding body mass index to the model (odds ratio, 2.18; 95% CI, 0.75-6.35).

Conclusions and Relevance  Patients with psoriasis have increased coronary artery calcium by mean total Agatston scores, similar to that of patients with type 2 diabetes, suggesting that patients with psoriasis harbor high rates of subclinical atherosclerosis beyond adjustment for body mass index. Major educational efforts for patients and physicians should be undertaken to reduce the burden of cardiovascular disease in patients with psoriasis.

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Figure.
Median Coronary Artery Calcium (CAC) as Assessed by Mean Agatston Scores

Increases in CAC scores were seen with increasing prevalence of traditional cardiovascular risk factors (RFs) in patients with psoriasis and patients with type 2 diabetes. Traditional cardiovascular RFs are defined as age older than 55 years, hypertension (defined as systolic blood pressure >140 mm Hg, diastolic blood pressure >90 mm Hg, or normal blood pressure taking antihypertensive medications), hyperlipidemia (defined as high-density lipoprotein cholesterol level <40 mg/dL, low-density lipoprotein cholesterol level >160 mg/dL [to convert to millimoles per liter, multiply by 0.0259], or triglyceride levels >200 mg/dL [to convert to millimoles per liter, multiply by 0.0113], or normal lipid profile while taking antihyperlipidemia medications), current smoker, and family history of coronary artery disease. Error bars indicate interquartile ranges. P for trend <.001.

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