By Reuters Staff
NEW YORK (Reuters Health) - A study of patients with psoriasis shows that visceral fat plays a key role in vascular inflammation, beyond a patient's body-mass index.
In the study of middle-aged psoriasis patients, visceral adiposity was associated with cardiovascular disease risk factors, including vascular inflammation. The relationship with vascular inflammation “remained robust beyond cardiovascular risk factors for visceral compared to subcutaneous adiposity,” the investigators report.
They also observed that treating psoriasis led to improvements in vascular inflammation and visceral adiposity, suggesting that “modulation of visceral adipose volume may play a role in reducing vascular inflammation and subsequent cardiovascular disease risk in a chronic inflammatory state.”
Joshua Rivers and colleagues at the National Institutes of Health (NIH) report their observations online October 18 in JACC: Cardiovascular Imaging.
An estimated 1 million Americans suffer moderate to severe psoriasis. “Although the psoriatic plaque may appear to be limited to the skin, its effects may be far-reaching and systemic leading to increased obesity and cardiometabolic disease risk,” the investigators note. “As such, measures of adiposity such as body mass index and waist-to-hip ratio are important to assess when caring for patients with psoriasis,” they write.
Using 18-FDG PET/CT imaging, the study team examined the relationship between visceral adiposity volume (VAT) and vascular inflammation in 77 patients with mild to moderate psoriasis, and sought to determine whether treating the psoriasis altered VAT and vascular inflammation. The cohort was middle-aged (mean age, 52) and predominantly male (57%) with a low cardiovascular risk determined by Framingham 10-year risk assessment.
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In this “well-phenotyped” sample of psoriasis patients followed for one year, the researchers report three key observations:
- Psoriasis severity seems to have a dose-response relationship with increasing cardiometabolic disease risk factors, visceral adiposity, and vascular inflammation.
- Visceral adiposity is associated with vascular inflammation beyond cardiovascular risk factors compared to subcutaneous adiposity, body-mass index, and waist-to-hip ratio.
- Repeat PET/CT imaging in 13 patients after one year of psoriasis treatment revealed decreases in visceral adiposity and arterial inflammation.
“These findings suggest that studies should focus on developing mechanistic understanding of the visceral adipose depot in psoriasis given the metabolic activity and contribution to atherogenesis from this depot remains poorly understood,” they conclude.
The authors of an accompanying editorial say these findings put forth visceral adiposity as “an important biomarker related to arterial inflammation” in psoriasis.
This study shows that visceral adipose tissue is a “metabolic key player in fueling arterial inflammation that likely contributes to progression of atherosclerosis and vulnerable plaque formation in psoriasis. Inflammation of the visceral adipose tissue per se may release various adipocytokines, such as leptin, adiponectin, ghrelin, and endocannabinoids altering coronary vasomotor dysfunction commonly seen as functional precursor of the CAD process,” write Dr. Thomas Hellmut Schindler from Johns Hopkins University School of Medicine in Baltimore and Dr. Pal Pacher from NIH.
They also note that anti-inflammatory medication plays a “central role” in improving cardiovascular outcome not only in patients psoriasis and other chronic inflammatory conditions, but also in classical cardiovascular risk individuals.
The study had no commercial funding.
SOURCES: https://bit.ly/2gJzrBs and https://bit.ly/2zDHELy
JACC Cardiovasc Imaging 2017.
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