The study results here provide an interesting comparison between the strategies of lowering inflammation and lowering blood cholesterol for the treatment of atherosclerosis. Atherosclerosis is the name given to the buildup of fatty lesions in blood vessel walls, a process that occurs in all of us with advancing age. These deposits narrow and weaken blood vessels, ultimately leading to a fatal rupture or blockage. This is one of the largest causes of human mortality. Unfortunately the present dominant approach of reducing blood cholesterol – via statins and similar therapies – doesn’t do more than modestly slow the condition, and only slightly diminishes the size of existing lesions. While atherosclerosis appears to have a strong inflammatory component, in that it progresses more rapidly in the presence of greater age-related chronic inflammation, dampening that inflammation doesn’t appear to do any better than reducing blood cholesterol when it comes to turning back the condition and reducing lesion size. Different approaches are going to be needed, perhaps along the lines of removing the lipids present in lesions more directly.
Chronic inflammation in people with psoriasis is associated with a higher risk of developing coronary artery disease. Biologic therapy medications are proteins that are given by injection or infusion and suppress the inflammation process by blocking the action of cytokines, which are proteins that promote systemic inflammation. Previous research has shown a clear link between psoriasis and the development of high-risk coronary plaque. This study provides characterization of a lipid-rich necrotic core, a dangerous type of coronary plaque made up of dead cells and cell debris that is prone to rupture. Ruptured plaque can lead to a heart attack or stroke.
The analysis involved 209 middle-aged patients (ages 37-62) with psoriasis who participated in the Psoriasis Atherosclerosis Cardiometabolic Initiative at the National Institutes of Health, an ongoing observational study. Of these participants, 124 received biologic therapy, and 85 were in the control group, treated only with topical creams and light therapy. To measure the effects of biologic therapy on arteries of the heart, the researchers performed cardiac computed tomography (CT) scans on all study participants before they started therapy and one year later. The CT results between the two groups were then compared.
Biologic therapy was associated with an 8% reduction in coronary plaque. In contrast, those in the control group experienced slightly increased coronary plaque progression. Even after adjusting for cardiovascular risk factors and psoriasis severity, patients treated with biologic therapy had reduced coronary plaque. “There is approximately 6-8% reduction in coronary plaque following therapy with statins. Similarly, our treatment with biologic therapy reduced coronary plaque by the same amount after one year. These findings suggest that biologic therapy to treat psoriasis may be just as beneficial as statin therapy on heart arteries.”