Cardiac structure and function is associated with systemic inflammation in psoriasis and palmoplantar pustulosis: the PSOCADIA study

Abstract Background Psoriasis is a chronic inflammatory skin disease linked to an increased risk of cardiovascular disease (CVD). High sensitivity C-reactive protein (hsCRP) detects systemic inflammation, which may be associated with cardiovascular risk in psoriasis. Purpose We aimed to evaluate the association between hsCRP levels and cardiac structure and function in a large cross-sectional analysis of prospectively included individuals with psoriasis and/or palmoplantar pustulosis (PPP). Methods Adults with psoriasis and/or PPP were recruited from dermatological out-patient clinics and private dermatologists, and underwent hsCRP assessment and transthoracic echocardiography. Systolic dysfunction was defined as left ventricular ejection fraction (LVEF) 50% and/or global longitudinal strain (GLS) 16%. Diastolic dysfunction was defined according to ASE guidelines. The population was stratified according to hsCRP quartiles and associations with cardiometabolic risk factors and measures of cardiac structure and function were examined with ANOVA, Pearson’s Chi2-test, Kruskal-Wallis test, linear and logistic regression as appropriate. The association between hsCRP levels and selected continuous parameters of systolic and diastolic function were examined using cubic spline models. Results We prospectively included 1,003 individuals with psoriasis and/or PPP, with a median age of 54 years (Table). The majority (71.9%) had moderate-to-severe psoriasis, but skin disease was generally well-managed. Biologics (45.3%) and methotrexate (24.8%) were the most commonly used psoriasis therapies. When stratified by hsCRP quartiles, individuals with the highest hsCRP levels were older and predominantly female (55.1%, p0.001). While the distribution of moderate-to-severe psoriasis and psoriatic arthritis did not significantly differ across hsCRP quartiles, higher hsCRP levels were associated with an increased prevalence of obesity, hypertension, dyslipidemia, and atrial fibrillation (Table). Individuals with higher hsCRP had lower global longitudinal strain (GLS), higher E/e’ and tricuspid regurgitation (TR) peak velocity, suggesting worse systolic and diastolic function (p 0.001). Individuals in the highest hsCRP quartile had a higher proportion of LV systolic dysfunction (29.9%) and diastolic dysfunction (33.3%) compared to those in the lowest quartile (15.2% and 18.8%, respectively, p 0.001). Higher hsCRP levels was furthermore associated with worsening in GLS (p = 0.002), LVEF (p = 0.002), and e’ lateral velocity (p 0.001), and E/e’ (p 0.001) (Figure). Conclusions Higher hsCRP levels were associated with more adverse cardiometabolic profiles and altered LV systolic and diastolic function. These findings suggest that systemic inflammation, as reflected by hsCRP, may contribute to subclinical cardiac dysfunction in individuals with psoriasis and/or PPP. Further research is needed to determine whether aiming for low hsCRP levels can mitigate CVD risk.Table Figure