Treatment with tumor necrosis factor inhibitors restores coronary microvascular function in young patients with severe psoriasis

Autor: Dario Gregori, Irene Zanetti, Giulia Famoso, Anna Poretto, Sabino Iliceto, Elena Osto, Stefano Piaserico, Andrea Peserico, Francesco Tona
Rok vydání: 2016
Předmět:
Male
Coronary flow reserve
Pilot Projects
030204 cardiovascular system & hematology
Coronary Angiography
Etanercept
030207 dermatology & venereal diseases
0302 clinical medicine
Prospective Studies
biology
Middle Aged
Coronary Vessels
Echocardiography
Doppler
Fractional Flow Reserve
Myocardial
C-Reactive Protein
medicine.anatomical_structure
Cardiology
Female
Cardiology and Cardiovascular Medicine
medicine.drug
Adult
medicine.medical_specialty
03 medical and health sciences
Coronary circulation
Psoriasis Area and Severity Index
Coronary Circulation
Psoriasis
Internal medicine
Adalimumab
medicine
Humans
Inflammation
Tumor Necrosis Factor-alpha
business.industry
Microcirculation
C-reactive protein
medicine.disease
Infliximab
Coronary microcirculation
Risk factors
Chronic Disease
Multivariate Analysis
biology.protein
business
Zdroj: Atherosclerosis. 251:25-30
ISSN: 0021-9150
DOI: 10.1016/j.atherosclerosis.2016.05.036
Popis: In patients with psoriasis, the chronic exposure to systemic inflammation can result in coronary microvascular dysfunction (CMD). In this self-controlled, prospective pilot study, we investigated whether a long-term treatment with TNF-α inhibitors effective against skin symptoms also improves coronary flow reserve in psoriasis patients (CFR).We prospectively studied 37 consecutive psoriasis patients (31 male; age, 37.7 ± 8.5 years) without cardiovascular disease, before and after anti-TNF-α treatment. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. A CFR≤2.5 was considered a marker of CMD. Psoriasis was assessed by Psoriasis Area and Severity Index (PASI). High sensitive C-reactive protein (hs-CRP) and serum TNF-α were assessed.Overall, CFR increased from 2.2 ± 0.7 to 3.02 ± 0.8 (p 0.0001) after TNF-α inhibitors therapy. In patients with CMD, CFR increased from 1.88 ± 0.3 to 2.74 ± 0.5 (p 0.0001). In patients with normal CFR, CFR increased from 3.0 ± 0.5 to 3.7 ± 0.9 (p = 0.08). CFR improvement after TNF-α inhibitors treatment was correlated with hs-CRP and TNF-α reduction (p = 0.004 and p = 0.02, respectively), but not with change in PASI (p = 0.5).The present study demonstrates that TNF-α inhibitors treatment ameliorates CMD in patients with established psoriasis not responding to long-term conventional therapy. These findings suggest that a therapy specifically targeted against inflammation is able to positively affect coronary microvascular function.
Databáze: OpenAIRE
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