During his presentation entitled, “Comorbidities in Psoriasis,” Alvaro Gonzalez Cantero, MD, PhD, highlighted the links between psoriasis and cardiovascular disease by taking a look at Dr Nehal Mehta’s imaging technique.

His points of interest centered around atherosclerosis and its relations to:

• heart attack;
• coronary disease; and
• non-calcified plaque.

“As some of you know, heart attack remains the leading cause of death worldwide, and atherosclerosis is the leading cause of heart attack,” Dr Gonzalez Cantero stated at the start of his lecture. “We now know that inflammation accelerates atherosclerosis,” he continued.

Referencing a famous article by Dr Joel Gelfand, he showed that patients with psoriasis have a 50% increase of cardiovascular disease compared to the general population, and that the youngest population, with patients between 40-50 years old, there was a twofold increase in the first heart attack.

For coronary disease, Dr Gonzalez Cantero opened this discussion with the question, “Can we detect [coronary disease] before it manifests in a myocardial infarction?”

He introduced coronary computed tomography angiography (CCTA) referencing Dr Nehal Mehta’s imaging technique in which Toshiba 320-slices were utilized and, when taking every coronary artery, it gets isolated into four views. This helps with determining plaque volume which in turn can lead into determining the plaque index—which is actually where atherosclerosis starts and is called the non-calcified body. Dr Gonzalez Cantero emphasized that non-calcified plaque is the most common cause of myocardial infarction.

Looking at the images provided from the Dr Mehta’s CCTA, Dr Gonzalez Cantero noted outward protrusions introducing them as positive remodeling, which is one of the highest risk features for rupture and heart attack. He added that the bottom of the image showed another risk factor highlighting they were the lipids that, once the lipids go to the wall of the artery, they go to the plaque, and they make the plaque easier to rupture. He called this low attenuation.

“It is this kind of data that I like to share with my patients—mostly those recently diagnosed with psoriasis when they are young—to see that disease has its consequences,” he concluded.

You can hear more insights from Dr Gonzalez Cantero from our on-site podcast here.

Reference
Gonzalez-Cantero A. Comorbidities in psoriasis. Presented at: AAD Annual Meeting; March 25-28, 2022; Boston, MA.