title: Comparison of Coronary Artery Calcium Scores Between Patients With Psoriasis and Type 2 Diabetes.
abstract: Psoriasis is associated with an increased risk of cardiovascular diseases. Subclinical atherosclerosis in patients with psoriasis has not been compared with other conditions associated with increased cardiovascular risk and more rigorous cardiovascular disease screening, such as type 2 diabetes.
  
  
  
  To assess the burden of asymptomatic coronary atherosclerosis measured by coronary artery calcium score in patients with moderate to severe psoriasis compared with patients with type 2 diabetes and healthy controls.
  
  
  
  Three single-center, cross-sectional studies were performed in patients recruited from specialty outpatient clinics with moderate to severe psoriasis without type 2 diabetes (recruited from November 1, 2013, through April 31, 2015), patients with type 2 diabetes without psoriasis or other inflammatory diseases (recruited from July 1, 2009, through June 20, 2011), and age- and sex-matched healthy controls without psoriasis, type 2 diabetes, or other inflammatory diseases (recruited from July 1, 2009, through June 20, 2011).
  
  
  
  Psoriasis, type 2 diabetes, and healthy control effect on coronary artery calcium score.
  
  
  
  Coronary artery calcium measured by Agatston score.
  
  
  
  A total of 387 individuals participated in the study. Mean (SD) age was 51 (7.7), 52 (8.0), and 52 (8.0) years in the psoriasis, type 2 diabetes, and healthy control cohorts, respectively. There were 64 men (49.6%) in each group, and most patients were white (119 [92.2%], 123 [95.3%], and 128 [99.2%] in the psoriasis, type 2 diabetes, and healthy control cohorts, respectively). Patients with psoriasis had low cardiovascular risk measured by the Framingham Risk Score but had a high prevalence of cardiovascular and cardiometabolic risk factors, similar to patients with type 2 diabetes. In a fully adjusted model, psoriasis was associated with coronary artery calcium (Tobit regression ratio, 0.89; P < .001) similar to the association in type 2 diabetes (Tobit regression ratio, 0.79; P = .04). Likelihood ratio testing revealed incremental value for psoriasis in a fully adjusted model (χ2 = 4.48, P = .03) in predicting coronary artery calcium. Psoriasis was independently associated with the presence of any coronary artery calcium (odds ratio, 2.35; 95% CI, 1.12-4.94) in fully adjusted models, whereas the association of coronary artery calcium with type 2 diabetes was no longer significant after adding body mass index to the model (odds ratio, 2.18; 95% CI, 0.75-6.35).
  
  
  
  Patients with psoriasis have increased coronary artery calcium by mean total Agatston scores, similar to that of patients with type 2 diabetes, suggesting that patients with psoriasis harbor high rates of subclinical atherosclerosis beyond adjustment for body mass index. Major educational efforts for patients and physicians should be undertaken to reduce the burden of cardiovascular disease in patients with psoriasis.
authors.affiliation: Division of Dermatology, Baylor University Medical Center, Dallas, Texas2Department of Dermatology, Baylor Scott and White Health, Temple, Texas.
authors.forename: Bobbak
authors.initials: B
authors.lastname: Mansouri
authors.affiliation: Division of Dermatology, Baylor University Medical Center, Dallas, Texas3Baylor Institute for Immunology Research, Dallas, Texas.
authors.forename: Dario
authors.initials: D
authors.lastname: Kivelevitch
authors.affiliation: University of Arizona College of Medicine at South Campus, Tucson5National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Balaji
authors.initials: B
authors.lastname: Natarajan
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Aditya A
authors.initials: AA
authors.lastname: Joshi
authors.affiliation: Division of Dermatology, Baylor University Medical Center, Dallas, Texas.
authors.forename: Caitriona
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Texas A&M Health Science Center College of Medicine, Temple.
authors.forename: Katie
authors.initials: K
authors.lastname: Benjegerdes
authors.affiliation: Division of Cardiology, Baylor University Medical Center, Dallas, Texas8Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas9Texas A&M Health Science Center College of Medicine, Dallas.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Schussler
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Rader
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia11Division of Cardiology, Department of Medicine, Columbia University, New York, New York12Irving Institute for Clinical and Translational Research, Columbia University, New York, New York.
authors.forename: Muredach P
authors.initials: MP
authors.lastname: Reilly
authors.affiliation: Division of Dermatology, Baylor University Medical Center, Dallas, Texas.
authors.forename: Alan
authors.initials: A
authors.lastname: Menter
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Nehal N
authors.initials: NN
authors.lastname: Mehta
mesh_terms: D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011565:Psoriasis / Q000097:blood* / Q000150:complications; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology