title: Treatment with tumor necrosis factor inhibitors restores coronary microvascular function in young patients with severe psoriasis.
abstract: 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.
authors.affiliation: Department of Medicine, University of Padova, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Piaserico
authors.affiliation: Centre for Molecular Cardiology, University of Zurich and University Heart Center, Cardiology, University Hospital Zurich, Switzerland.
authors.forename: Elena
authors.initials: E
authors.lastname: Osto
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Famoso
authors.affiliation: Department of Medicine, University of Padova, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Zanetti
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Poretto
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Department of Medicine, University of Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Peserico
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. Electronic address: francescotona@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tona
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects*; D003331:Coronary Vessels / Q000503:physiopathology; D015150:Echocardiography, Doppler; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011446:Prospective Studies; D011565:Psoriasis / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000097:blood
chemical_list: D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Coronary flow reserve; Coronary microcirculation; Inflammation; Psoriasis; Risk factors