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Coronary Artery Disease Assessed by Computed Tomography in Patients with Psoriasis: A Systematic Review and
Hannah Kaiser1, Jawdat Abdulla2, Kristoffer M A Henningsen3
1Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark, hannahkaiser90@gmail.com.
Insights
Patients with psoriasis have a significantly higher prevalence and burden of coronary artery disease (CAD), including more high-risk coronary plaques, compared to individuals without the condition. This highlights the increased cardiovascular risk associated with psoriasis.
Area of Science:
- Cardiology
- Dermatology
- Public Health
Background:
- Psoriasis is linked to an increased risk of coronary artery disease (CAD).
- Existing data on coronary calcium score (CCS) and cardiac computed tomography angiography (CCTA) in psoriasis patients are inconsistent.
- Subclinical CAD assessment in psoriasis requires further quantitative synthesis.
Purpose of the Study:
- To quantitatively summarize literature data on CAD prevalence and burden in psoriasis patients versus controls.
- To utilize CCS and CCTA findings for a comprehensive comparison.
- To establish the association between psoriasis and subclinical CAD using meta-analysis.
Main Methods:
- Systematic review and meta-analysis of studies published between 2000 and May 2018.
- Inclusion of studies assessing CAD prevalence and burden via CCS with or without CCTA.
- Comparison between psoriasis patients without prior CAD and control groups.
Main Results:
- Fourteen studies with 1,427 psoriasis patients and 9,670 controls were analyzed.
- Psoriasis patients showed an increased risk of CAD (RR 1.14) and more severe CAD (CCS >100, RR 1.71).
- Higher CCS (mean difference 12.74) and increased risk of high-risk coronary plaques (RR 1.77) were observed in psoriasis patients.
Conclusions:
- Patients with psoriasis exhibit a higher prevalence of subclinical CAD.
- Psoriasis is associated with a greater burden of coronary artery disease.
- Psoriasis patients demonstrate a significantly higher occurrence of high-risk coronary plaques compared to controls.
Background:
Patients with psoriasis have an increased risk of coronary artery disease (CAD) but data on coronary calcium score (CCS) and cardiac computed tomography angiography (CCTA) are inconsistent.
Objectives:
The present study quantitatively summarizes the literature data on the prevalence and burden of CAD in patients with psoriasis compared with controls using CCS and CCTA.
Methods:
A systematic review and meta-analysis was conducted. The search included all studies examining CAD prevalence and burden detected by CCS with or without CCTA in patients with psoriasis without prior CAD compared with controls, between the year 2000 and May 30, 2018.
Results:
Fourteen eligible studies provided data on 1,427 patients with psoriasis and 9,670 controls. Pooled data provided the estimated risk ratio (RR) of CAD and weighted mean differences of CCS in psoriasis patients versus controls. Meta-analysis of the prevalence and burden of CCS showed that patients with psoriasis had an increased risk of CAD (RR 1.14, 95% CI 1.04-1.26; p = 0.004), and for more severe CAD (CCS >100) the risk was further increased (RR 1.71, 95% CI 1.28-2.30; p < 0.001) compared with controls. Weighted mean difference for CCS was significantly higher in patients with psoriasis (12.74, 95% CI 10.70-14.78; p < 0.001). The risk of high-risk coronary plaques identified by CCTA was also significantly higher in psoriasis patients compared with controls (RR 1.77, 95% CI 1.37-2.28; p < 0.001).
Conclusions:
Patients with psoriasis have a higher prevalence of subclinical CAD, a higher burden of the disease, and more high-risk coronary plaques compared with controls without psoriasis.
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