Anti-inflammatory psoriasis agents could prevent heart disease

Ask your doctor if this treatment could vastly reduce your chances of getting another stroke or heart attack.
What other treatments does your doctor have you on to reduce atherosclerosis? Any of these? Or is your doctor not treating your vascular inflammation at all?

VIP-U: Psoriasis treatment reduces vascular inflammation Feb. 2018

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New study shows aged garlic extract can reduce dangerous plaque buildup in arteries  Jan. 2016 

The latest here:

 

Anti-inflammatory psoriasis agents could prevent heart disease

Elnabawi YA, et al. Cardiovasc Res. 2019;doi:10.1093/cvr/cvz009.

February 5, 2019

Anti-inflammatory biologic therapy for treatment of severe psoriasis reduced coronary artery plaque, raising questions about whether such agents could have a role in prevention of CHD, researchers reported in Cardiovascular Research.
“Classically a heart attack is caused by one of five risk factors: diabetes, hypertension, high cholesterol, family history or smoking,” Nehal N. Mehta, MD, chief of inflammation and cardiometabolic diseases at the NHLBI, said in a press release from the NIH. “Our study presents evidence that there is a sixth factor, inflammation; and that it is critical to both the development and the progression of atherosclerosis to heart attack.”

Mehta and colleagues conducted a prospective observational study of 121 patients with moderate to severe psoriasis and low risk for CVD (mean age, 51 years; 58% men; median Framingham risk score, 3), who completed 1-year follow-up and had not had biologic treatment at baseline. During the study period, 89 patients were treated with biologic therapy.
All patients underwent coronary CTA at baseline and 1 year to quantify total plaque coronary burden and plaque subcomponents in three coronary vessels of at least 2 mm in diameter.
According to the researchers, biologic therapy was associated with reductions in noncalcified plaque burden (6%; P = .005) and necrotic core (57%; P = .03), but not in fibrous burden (P = .71).
Compared with patients who were not treated with biologics, those who were had a greater decrease in noncalcified plaque burden (–0.07 mm² vs. 0.06 mm²; P = .02), which persisted after adjustment for traditional CV risk factors (beta = 0.2; P = .02), Mehta and colleagues wrote.
The group treated with biologics had a reduction in C-reactive protein at 1 year (P < .001), but the untreated group did not (P = .21).
The treatment effect was greatest in patients treated with , according to the researchers.
“We found that these anti-inflammatory drugs commonly used to treat severe psoriasis also improve plaque in the coronary artery, making them more stable and less likely to cause a heart attack. This occurred in the absence of changes in traditional cardiovascular risk factors including blood pressure and blood lipids,” Mehta said in a press release from the European Society of Cardiology. “This preliminary study provides the first evidence that biologic therapy is associated with coronary plaque reduction and stabilization, and provides strong rationale for conduct of a randomized trial testing the impact of biologic therapy on the progression of coronary disease in patients with psoriasis.” – by Erik Swain
Disclosures: Mehta reports he received research grants to his employer, the NHLBI, from AbbVie, Celgene, Janssen and Novartis. Please see the study for all other authors’ relevant financial disclosures.

VIP-U: Psoriasis treatment reduces vascular inflammation

Ask your doctor if this treatment could vastly reduce your chances of getting another stroke or heart attack. 
What other treatments does your doctor have you on to reduce atherosclerosis? Any of these? Or is your doctor not treating your vascular inflammation at all?

Researchers develop new biomedical polymer to treat atherosclerosis May 2017 

Vitamin D and cardiovascular disease: From atherosclerosis to myocardial infarction and stroke Jan. 2017 

Watermelon juice reverses hardening of the arteries Nov. 2011 

New study shows aged garlic extract can reduce dangerous plaque buildup in arteries  Jan. 2016 

The latest here:

VIP-U: Psoriasis treatment reduces vascular inflammation

Vascular inflammation was reduced in patients who were treated for psoriasis with ustekinumab, according to results from the VIP-U study presented at the American Academy of Dermatology Annual Meeting.

“What’s important at this stage is the concept and the promise,” Joel M. Gelfand, MD, MSCE, director of the Psoriasis and Phototherapy Treatment Center, vice chair of clinical research, medical director of the dermatology clinical studies unit, professor of dermatology and professor of epidemiology in biostatistics and epidemiology at the University of Pennsylvania, told Cardiology Today. “We know inflammation is an important risk factor for CVD. Just recently, the CANTOS trial proved that blocking inflammation with an antibody against interleukin-1b lowers the risk of major cardiovascular events

. Our study demonstrates that blocking interleukin-12/23 not only improves inflammation in the skin, joints and bowels, but also in the aorta, proving that it is capable of biologically hitting the target.” Researchers analyzed data from 43 patients (mean age, 42 years) who had a psoriasis area severity index greater than 12 and a body surface area of at least 10. At baseline, patients were washed out of their psoriasis treatment. Patients were assigned to ustekinumab (Stelara, Janssen) or placebo for 12 weeks. The primary outcome of interest was aortic inflammation, which was measured by fluorine-18 fluorodeoxyglucose PET/CT scans at baseline and 12 weeks. At 12 weeks, 41 patients completed the trial. Seventy-seven percent of patients assigned ustekinumab achieved a 75% reduction in psoriasis area severity index compared with 11% of patients in the placebo group (P < .001). At the end of the study, total aortic vascular inflammation was reduced by 6.6% in patients assigned ustekinumab and increased by 12.1% in patients assigned placebo (P = .001). “There is a need for treatments that can lower CV risk by modulating inflammation while not significantly increasing the risk of side effects such as infection,” Gelfand told Cardiology Today. “The emerging biologics in psoriasis have an impressive safety profile and may ultimately prove to offer benefits beyond the skin, extending to cardiovascular disease prevention.” – by Darlene Dobkowski Gelfand JM, et al. Abstract 6645. Presented at: American Academy of Dermatology Annual Meeting; Feb. 16-20, 2018; San Diego. The study was funded by Janssen Scientific Affairs. Gelfand reports he is a consultant for Bristol-Myers Squibb, Coherus, Dermira, Dr. Reddy’s Labs, GlaxoSmithKline, Janssen Biologics, Menlo Therapeutics, Novartis, Pfizer, Regeneron and Sanofi; receives honoraria and research grants from AbbVie, Celgene, Janssen, Novartis, Pfizer, Regeneron and Sanofi; and has received payment for CME work related to psoriasis that was supported by AbbVie, Lilly and Valeant.

Can Psoriasis Tx Diminish Atherosclerosis?

What other treatments does your doctor have you on to reduce atherosclerosis? Any of these?

Researchers develop new biomedical polymer to treat atherosclerosis May 2017 

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Watermelon juice reverses hardening of the arteries Nov. 2011 

New study shows aged garlic extract can reduce dangerous plaque buildup in arteries  Jan. 2016 

Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation  June 2004 

 

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Can Psoriasis Tx Diminish Atherosclerosis?

Observational study links improvements in skin, vascular inflammation

• by Nicole Lou, Contributing Writer, MedPage Today June 01, 2017

Treatments that eased psoriasis were tied to reductions in vascular inflammation as well, a small study found.
After a year of treatment for the skin condition -- a mix of of topical therapy (60%), biological therapy (66%, mostly anti-tumor necrosis factor [anti-TNF] therapy), and phototherapy (15%) -- there was a median 33% improvement in psoriasis (P<0.001) that was linked to a 6% reduction in vascular inflammation as measured by PET/CT, even after adjusting for traditional risk factors (P=0.03), according to Nehai N. Mehta, MD, MSCE, of the National Heart, Lung, and Blood Institute in Bethesda, Md., and colleagues.

They noted in their JAMA Cardiology study that patients achieving at least a 75% reduction in skin inflammation severity had an 11% improvement in vascular inflammation (P<0.003).
"These findings suggest that controlling remote target organ inflammation (e.g., in the skin) may improve vascular diseases; however, randomized clinical trials are needed to confirm these findings," wrote Mehta's group.
For one, the randomized Vascular Inflammation in Psoriasis-Extension Trial is in the works as investigators study the effect of anti-TNF therapy with adalimumab on skin and vascular inflammation.
"These data are intriguing and support a rigorous testing of the hypothesis that intervening on psoriatic disease may mitigate vascular disorders, but there are several unanswered questions that frame our understanding of the role of inflammation in vascular disease," according to Calum A. MacRae, MD, PhD, of Brigham and Women's Hospital in Boston.
Writing in an accompanying editorial, MacRae said it was unclear "whether the correlation observed by [the authors] reflects a shared pathobiology or a serendipitous shared responsiveness to a specific anti-inflammatory intervention. It is difficult to infer from these data that treating skin inflammation directly results in diminished vascular inflammation."
"Even mild cases of psoriasis exhibit evidence of fluorodeoxyglucose uptake, particularly in the proximal aorta, but the distribution of these findings in the arterial tree and the absence of reliable correlates in typical atherosclerotic coronary disease complicates straightforward inferences regarding the underlying biology."
Mehta and colleagues admitted that their observational study left room for residual confounding despite adjustment. Furthermore, participants got a mix of therapies that precluded drawing any conclusions about the role of anti-TNF therapy.
Their prospective study had followed 220 patients, with 115 consecutive participants making it to 1-year follow-up. Mean age of the participants was 49.7 years; the group was 59% men. The study population also started with low baseline cardiovascular risk (Framingham risk score) and mild-to-moderate psoriasis (median Psoriasis Area and Severity Index score 5.2).
Psoriasis severity, measured as a Psoriasis Area and Severity Index score, was associated with vascular inflammation at baseline (P=0.03). Vascular inflammation, a well-known contributor to atherosclerosis, was quantified as target-to-background ratio on ¹⁸fluorodeoxyglucose positron emission tomography/CT.
Moving forward, it's important to further elucidate the role of inflammation in atherosclerosis, MacRae suggested.
"Inflammation affects multiple stages of human atherosclerosis. Cellular and humoral immunity have been implicated in the initiation and evolution of atherosclerotic plaques, in plaque vulnerability, and in acute coronary syndromes," he said. "Distinctive inflammation biology has also been implicated in other vascular syndromes, including aortic root disease, carotid arteriopathy, and peripheral arterial disease, revealing a substantial etiologic heterogeneity that has been confirmed by genetics and other studies."
"Despite these insights and increases in our understanding of the role of inflammation in atherosclerosis models, immunology has hardly influenced clinical cardiology."

Mehta and MacRae disclosed no relevant conflicts of interest.
Study co-authors reported numerous relationships with industry.

• Primary Source

  JAMA Cardiology

  Source Reference: Dey AK, et al "Association between skin and aortic vascular inflammation in patients with psoriasis: a case-cohort study using positron emission tomography/computed tomography" JAMA Cardiol 2017; DOI: 10.1001/jamacardio.2017.1213.

• Secondary Source

  JAMA Cardiology

  Source Reference: MacRae CA "Skin and vascular disease -- inside-out/outside-in" JAMA Cardiol 2017; DOI: 10.1001/jamacardio.2017.1420.

The effects of garlic extract upon endothelial function, vascular inflammation, oxidative stress and insulin resistance in adults with type 2 diabetes at high cardiovascular risk.

If we had any strategy at all for stroke this study would be followed up because of endothelial function. But it won't be because we have NO leadership in stroke and fucking failures of stroke associations. Would this work in stroke patients without diabetes?
http://www.mdlinx.com/internal-medicine/medical-news-article/2016/01/08/diabetes-aged-garlic-extract-endothelial-function/6485379/?news_id=387&newsdt=011616&subspec_id=4&utm_source=WeeklyNL&utm_medium=newsletter&utm_content=Weeks-Best-Article&utm_campaign=article-section&category=latest-weekly

Journal of Diabetes and its Complications, 01/08/2016

Atkin M, et al. – This study tested the hypothesis that Aged Garlic Extract (AGE) may improve endothelial function, oxidative stress, vascular inflammation and insulin resistance in high risk cardiovascular subjects with type 2 diabetes. In this group of type 2 diabetic patients at high cardiovascular risk, 4 weeks treatment with AGE did not significantly improve endothelial function, vascular inflammation, oxidative stress or insulin resistance.

Methods

• A double blind, placebo controlled cross-over pilot study was performed in 26 subjects with type 2 diabetes who received 1200mg of AGE or placebo daily for 4 weeks with a 4 week washout period.
• Plasma HsCRP was measured as a marker of inflammation.
• Plasma TAOS,blood GSH/GSSG and plasma LHP were measured as markers of oxidative stress/anti-oxidant defence.
• Insulin resistance was measured using the HOMA-IR method.
• Endothelial function was measured using change in the reflective index (RI) post salbutamol using digital photoplethysmography and urinary albumin/creatinine ratio was measured as a biochemical surrogate.
• Measurements were taken at baseline and after intervention with AGE or placebo.

Results

• Of the 26 patients studied (Male 17, Female 9), age was 61 ± 8 yrs (mean ± 1 SD), HbA1c 7.2 ±1.1%, BP 130/75 ±15.9/9.8 mmHg , total cholesterol 4.2 ±0.81mmol/l, triglyceride 2.11 ± 1.51mmol/l, HDL-cholesterol 1.04 ± 0.29mmol/l.
• The majority of patients were being treated with metformin (59%), aspirin (50%) and statin (96%) therapy. 36% were treated with an ACEI.
• There were no changes in these therapies throughout the study.
• Treatment with AGE had no significant effect upon the above metabolic parameters including insulin resistance.
• Treatment with AGE also had no significant effect on markers of endothelial function (plethysmography), oxidative stress (TAOS, GSH/GSSG, LHP) or inflammation (HsCRP).