People with psoriasis who are on biologic therapies may get an added boost to their overall health: a reduced risk of heart disease.
According to a study published in the September 2020 issue of the journal Circulation: Cardiovascular Imaging, people who received biologics like adalimumab and ustekinumab for one year to manage their psoriasis had lower levels of a type of coronary plaque called lipid-rich necrotic core (LRNC) compared with people who didn’t receive the drugs.
LRNC has been linked with higher risk of heart attack and stroke in people with coronary artery disease.
The Centers for Disease Control and Prevention (CDC) describes plaque as cholesterol deposits that accumulate on the walls of arteries, causing blockages that can lead to coronary artery disease. Coronary artery disease is the most common form of heart disease in the United States, affecting an estimated 18 million people, the CDC says.
“[Our] current hypothesis is that treatment of psoriasis may result in a lowering of the risk of cardiovascular disease over time,” explains Joel M. Gelfand, MD, director of the Psoriasis and Phototherapy Treatment Center at University of Pennsylvania’s Perelman School of Medicine Philadelphia, who was one of the coauthors of the new study.
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How Biologics Work
It seems biologic therapy as well as phototherapy — two commonly used treatments for psoriasis — may both work to reduce levels of LRNC in the blood. LRNC is among several leading biomarkers (measurable signs) that can predict future heart attacks, Dr. Gelfand says.
Biologics, which target specific areas of the immune system, have been used for psoriasis treatment since the early 2000s. The biologics used to treat psoriatic disease block the action of a specific type of immune cell — a T cell — or proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23, according to the National Psoriasis Foundation.
TNF-alpha and the interleukins all play a major role in psoriasis and psoriatic arthritis.
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A Closer Look at the Study
For the new study, Gelfand and his colleagues enrolled 209 people with psoriasis who had not yet been treated with biologics. Roughly one-half were prescribed biologic therapies to treat their condition, while the rest were not.
LRNC for people in both groups was assessed using coronary computed tomography angiography, with measurements taken at the beginning of the study and, again, one year later.
On average, those who received biologic therapy saw their LRNC decline from 3.12 square millimeters (mm2) to 2.97 mm2 — or about 5 percent. Conversely, those who weren’t on biologic therapy saw LRNC increase from 3.12 to 3.34 mm2, on average — a 6 percent rise.
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Heart Disease and Psoriasis
Although larger studies are needed to confirm the positive effects of biologics on LRNC and heart disease risk, the findings are “exciting,” Gelfand says, because recent research suggests that people with psoriasis are at increased risk for heart disease.
“And this risk is more clinically significant in those with more severe skin disease,” Gelfand notes. “People with psoriasis should be screened for traditional cardiovascular risk factors such as high blood pressure, diabetes, and high cholesterol, and they should adopt a heart-healthy lifestyle — whether they’re on biologics or not.”
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