Prevalence, multiterritorial vascular distribution, and burden of subclinical atherosclerosis in psoriasis : The EDSAP study

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Abstract

Background: Psoriasis increases atherosclerosis risk due to inflammation. To date, subclinical atherosclerosis (SA) in psoriasis has only been studied in individual vascular territories by imaging. Objective: To conduct a comprehensive evaluation of multiterritorial SA prevalence in psoriasis by imaging and establish its relationships with cardiovascular (CV) risk scores. Methods: A total of 120 patients with moderate-to-severe psoriasis without CV disease from the Early Detection of Subclinical Atherosclerosis in Psoriasis (EDSAP) cohort underwent vascular ultrasound of carotid/femoral arteries and noncontrast/contrast-coronary computed tomography angiography. SA was defined by the presence of any plaque or a coronary artery calcium score ≥1. Results: The median age was 48.04 (8.25) years, 73% were male, and 77% of participants had SA. Femoral arteries were most affected (57.1%), followed by the coronaries (51.3%) and carotid arteries (49.6%). Femoral plaques exhibited the strongest associations with coronary parameters. CV risk scores underestimated SA, as at least 60% low-risk and 90% moderate-risk patients had SA. Limitations: The main limitation is the small sample size. Conclusions: This study provides the first multiterritorial assessment of SA in psoriasis, revealing a high prevalence of early disease. Femoral arteries were most affected, correlating with coronary atherosclerosis. The high SA detection within low-/intermediate-risk individuals suggests recalibrating CV scores for establishing effective preventive measures.