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Performance of Coronary Artery Calcium Testing in Patients With Severe Psoriasis: Risk Assessment and
A Martinez-Domenech1, J Forner Giner2, G Pérez-Pastor1
1Department of Dermatology, Consorci Hospital General Universitari de Valencia, Valencia, Spain.
Insights
Severe psoriasis patients show high rates of subclinical coronary artery disease (CAD). Coronary artery calcium (CAC) testing aids in cardiovascular risk reclassification for these individuals.
Area of Science:
- Cardiology
- Dermatology
- Radiology
Background:
- Patients with severe psoriasis exhibit elevated cardiovascular (CV) risk and subclinical coronary artery disease (CAD).
- Coronary artery calcium (CAC) testing offers improved CV risk assessment beyond traditional clinical scores.
Purpose of the Study:
- To evaluate subclinical CAD presence and magnitude via CAC scoring in severe psoriasis patients across different CV risk categories.
- To assess the potential for CV risk reclassification using CAC scores in this population, originating from a low CV risk background.
Main Methods:
- A cross-sectional study involving 111 severe chronic plaque psoriasis patients from a low CV risk Mediterranean population.
- Patients were stratified into four CV risk categories per ESC/EAS guidelines.
- Coronary computed tomography was used to determine CAC scores, with specific criteria for risk reclassification.
Main Results:
- Subclinical CAD was detected in 41.4% of patients.
- Among non-high-risk categories, 25.6% had subclinical CAD, with 17.1% eligible for risk reclassification.
- Age was the sole predictor for both subclinical CAD presence and risk reclassification.
Conclusions:
- Over 40% of severe psoriasis patients from low-risk regions possess subclinical CAD, with up to 25% in non-high-risk groups.
- CAC testing is valuable for refining CV risk assessment in severe psoriasis patients.
- Further investigation is needed to integrate CAC testing into routine dermatology practice for severe psoriasis management.
Background:
Patients with severe psoriasis have an increased cardiovascular (CV) risk and prevalence of subclinical coronary artery disease (CAD). Coronary artery calcium (CAC) testing can detect subclinical CAD and improve cardiovascular risk assessment beyond clinical scores.
Objectives:
Evaluate the presence and magnitude of subclinical CAD determined by CAC score among the different ESC/EAS CV risk categories, as well as the potential for risk reclassification, in patients with severe psoriasis from a low CV risk population.
Methods:
Unicentric cross-sectional study in 111 patients with severe chronic plaque psoriasis from a low CV risk population in the Mediterranean region. Patients were classified into four CV risk categories according to the ESC/EAS guideline recommendations and HeartScore/SCORE calibrated charts. Patients underwent coronary computed tomography to determine their CAC scores. Patients in the moderate-risk category with a CAC score of ≥100 were considered to be reclassified as recommended by the 2019 ESC/EAS guidelines. Reclassification was also considered for patients in the low-risk category with a CAC score>0.
Results:
Presence of subclinical CAD was detected in 46 (41.4%) patients. These accounted for 86.2% of patients in high/very-high-risk categories and 25.6% of patients in non-high-risk categories. Fourteen (17.1%) of the patients in non-high-risk categories were reclassifiable due to their CAC score. This percentage was higher (25%) when considering the moderate-risk category alone and lower (13.8%) in the low-risk category. Age was the only variable associated with presence of subclinical CAD and reclassification.
Conclusions:
Over 40% of patients with severe psoriasis from a low-risk region and up to 25% of those in non-high-risk categories have subclinical CAD. CAC appears to be useful for reclassification purposes in CV risk assessment of patients with severe psoriasis. Further research is required to elucidate how CAC could be implemented in everyday practice at outpatient dermatology clinics dedicated to severe psoriasis.
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