Photo Credit: Artur Plawgo
At Maui Derm Hawaii, held January 22-26, 2024, Joel Gelfand, MD, MSCE, presented as part of “Challenging Cases in Psoriasis.” Dr. Gelfand published two papers recently in this area of study, which we summarize here. These studies were not directly part of Dr. Gelfand’s presentation.
Association of the Complement System With Subclinical Atherosclerosis in Psoriasis: Findings From an Observational Cohort Study
J Invest Dermatol. 2023: S0022-202X(23)03112-3.
Psoriasis, characterized by chronic inflammation affecting the skin and joints, is associated with various co-morbidities and cardiovascular risk factors. As a result, individuals with psoriasis face an elevated risk of cardiovascular diseases, such as atherosclerosis. Atherosclerosis, a chronic condition sharing inflammatory and immune-response mechanisms with psoriasis, involves vascular inflammation and complement activation. In order to unravel the connection between atherosclerosis and psoriasis, a proteomics study followed by bioinformatics analysis was conducted, with subsequent validation using ELISA and western blotting.
When comparing plasma from patients solely with psoriasis to those with both psoriasis and atherosclerosis, 31 proteins of interest related to the complement system and oxygen transport were identified. Following validation, 11 proteins emerged as indicative of subclinical atherosclerosis in psoriasis patients, highlighting the significant role of complement cascades in the development of atherosclerotic plaques in individuals with psoriasis. These findings contribute to advancing our understanding of the pathological pathways underlying cardiovascular risk in this population. Moreover, they offer a promising foundation for developing predictive tools to enhance patient monitoring and designing more effective therapies.
The Relationship Between Circulating APOA-1 & Atherosclerosis Initiation & Progression in Psoriasis
J Invest Dermatol. 2023;143(10):1947-1954.
APOA-1 plays a crucial role in the functioning of high-density lipoprotein, particularly in reverse cholesterol transport, as indicated by cholesterol efflux capacity. Psoriasis, characterized by systemic inflammation, is linked to diminished cholesterol efflux capacity and an accelerated noncalcified coronary burden (NCB) measured through coronary computed tomographic angiography. This study aimed to elucidate the connection between APOA-1, cholesterol efflux capacity, and the progression of NCB over a 4-year period.
Participants with psoriasis, recruited consecutively, underwent coronary computed tomographic angiography for baseline NCB quantification (n=310) and a follow-up at four years (n=124). Blood samples were analyzed for cardiometabolic biomarkers. The lowest quartile of APOA-1 exhibited associations with cardiometabolic blood markers (insulin, homeostatic model assessment for insulin resistance, and cholesterol efflux capacity) and higher NCB (P<0.001). The low APOA-1 quartile was linked to higher NCB at the 4-year mark (β, -0.36, P=0.02) in fully adjusted models. Furthermore, a 10-unit decrease in APOA-1 correlated with a 16% increase in NCB progression over 4 years (OR, 0.83; 95% CI, 0.70-0.99; P=0.04).
Beyond its association with cardiometabolic disease, low APOA-1 was found to be connected with increased NCB over time. These results underscore the correlation between low APOA-1 levels and the initiation and progression of coronary artery disease, suggesting potential clinical utility in identifying high-risk populations for cardiovascular disease development.
For more information regarding Maui Derm Hawaii 2024, visit the conference website. Check here often for conference updates, psoriasis-focused abstracts and features, and more!
