Relation between psoriasis and atherosclerosis studied by coronary tomography

• Grant number: 11/07601-4
• Support Opportunities: Regular Research Grants
• Duration: June 01, 2011 - November 30, 2013
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Isabela Judith Martins Bensenor
• Grantee: Isabela Judith Martins Bensenor
• Host Institution: Hospital Universitário (HU). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Cid Yazigi Sabbag ; CLÁUDIO CAMPI DE CASTRO ; Henrique Lane Staniak ; Itamar de Souza Santos ; Márcio Sommer Bittencourt ; Paulo Andrade Lotufo ; Rodolfo Sharovsky ; Rodrigo Díaz Olmos

Abstract

The cardiovascular diseases have a high mortality. Classic risk factors are linked to those events. However, inflammation plays an important role in atherosclerosis, and inflammatory diseases can be associated with its development. Psoriasis is a chronic inflammatory disease which affects the skin and joints and has a prevalence of 2-3%. Various studies demonstrate a high risk fector prevalence in those patients, as well as its occurence being an independent risk factor. The calcium score evaluated by computed tomography measures the subclinical atherosclerosis and correlates extremely well with disease extension and prognosis for coronary artery disease. Studies demonstrate that patients with psoriasis have higher calcium scores, but event patients with zero calcium can have coronary plaques.The coronary angiotomography has a good accuracy for plaque and obstruction detection, comparable to invasive angiography. The IMT is another subclinical atherosclerosis marker which correlates well with cardiovascular events. The increased thickness is also a documented risk marker for patients with psoriasis. Methods:Transversal study that will enroll 400 patients divided in 3 grousp will be included: 100 mild psoriasis (no joint disease, no sistemic treatment), 100 severe psoriasis (joint involvement or sistemic treatment) and 200 controls, paired by sex, age and risk factors. Clinical evaluation will include anamnesis, weight, height, IMT, coronary angiography, blood samples (including creatinine, glucose, lipid profile and C reactive protein measurement).Inclusion Criteria:Age > 40 years old for women and 35 for men and mild or severe psoriasis with adeqaute follow up. Exclusion criteria:Contrast alergy, Renal failure, defined as creatinine >1,5 or creatinine clearence < 60 ml/min Known previous coronary artery disease defined as:Previous percutâneous coronary interventions,Previous myocardial infarction,Previous coronary artery bypass graft surgery,Pregnant women and Atrial fibrillationThe IMT will be measured with a Aplio XG (Toshiba) device with a 7,5 MHz linear vascular probe and resolution of 0,1 mm. The images will be analysed in a workstation using the software IMAGE ARENA-TOM TEC. The IMT will be measured in the distal common carotid artery, bulb and proximal internal carotid artery. Subclinical atherosclerosis will be defined as mean of the measures geater than percentil 95.The angiotomography will be performed with 2 Philips Brilliance 64 computed tomographers. Patients with heart rate above 60 will receive PO atenolol prior to the procedure. If necessary adition IV metoprolol will be used. Patients will also receive 5 mg nitroglycerin if not contra-indicated. Calcium score will be acquired according the usual standards with 120 Kvp and 55 mAs, with image acquisition at 75% of the RR interval. For coronary angiotomography the gated step & shot will be used with 120 Kvp and mAs adjusted to patient body habitus. Contrast flow rate will be adjusted to patient size with an expected use of 100 ml per patient.Expacted radiation dose is around 4 to 6 mSv. All images with be independently and blindly read by 2 experienced cardiologists. Where no agreement is reached a third cardiologis will read the scan. For calcium score quantification teh Agatston score will be used. For the angiotomography the 18 segment coronary three will be used, and obstruction will be graded as follows: No luminal obstruction,Less than 50% obstruction,50 - 70% obstruction and > 70% obstruction. (AU)