TY - JOUR
T1 - Chronic Stress-Related Neural Activity Associates With Subclinical Cardiovascular Disease in Psoriasis
T2 - A Prospective Cohort Study
AU - Goyal, Aditya
AU - Dey, Amit K.
AU - Chaturvedi, Abhishek
AU - Elnabawi, Youssef A.
AU - Aberra, Tsion M.
AU - Chung, Jonathan H.
AU - Belur, Agastya D.
AU - Groenendyk, Jacob W.
AU - Lerman, Joseph B.
AU - Rivers, Joshua P.
AU - Rodante, Justin A.
AU - Harrington, Charlotte L.
AU - Varghese, Nevin J.
AU - Sanda, Gregory E.
AU - Baumer, Yvonne
AU - Sorokin, Alexander V.
AU - Teague, Heather L.
AU - Genovese, Leonard D.
AU - Natarajan, Balaji
AU - Joshi, Aditya A.
AU - Playford, Martin P.
AU - Bluemke, David A.
AU - Chen, Marcus Y.
AU - Alavi, Abass
AU - Pitman, Roger K.
AU - Powell-Wiley, Tiffany M.
AU - Tawakol, Ahmed
AU - Gelfand, Joel M.
AU - Mehta, Nehal N.
N1 - Publisher Copyright:
© 2020
PY - 2020/2
Y1 - 2020/2
N2 - Objectives: This study hypothesized that there is an association between chronic stress (as indexed by resting amygdalar activity [AmygA]), hematopoietic system activity (HMPA), and subclinical cardiovascular indexes (aortic vascular inflammation [VI] and noncalcified coronary plaque burden [NCB]) in psoriasis (PSO). The study also hypothesized that treatment of PSO would improve these parameters. Background: PSO is a stress-related chronic inflammatory condition that is associated with increased prevalence of subclinical cardiovascular disease (CVD). In individuals without PSO, stress has been linked to CVD through a serial biological pathway that involves the amygdala, hematopoietic tissues, and atherosclerotic plaques. Methods: A total of 164 consecutive patients with PSO and 47 healthy volunteers underwent 18-fluorodeoxyglucose positron emission tomography/computed tomography scans for assessment of AmygA, HMPA, and VI, as well as coronary computed tomography angiography scans for quantifying NCB. Furthermore, a consecutive subset of 30 patients with severe PSO (Psoriasis Area Severity Index Score >10) were followed at 1 year to assess the relationship between skin disease improvement and AmygA, HMPA, VI, and NCB. Results: The PSO cohort was middle-aged (mean age: 50 years), had low cardiovascular risk (Framingham risk score: median: 3) and had mild to moderate PSO activity (median Psoriasis Area Severity Index Score: 5.6). AmygA was higher in patients with PSO compared to volunteer participants. AmygA was associated with HMPA (bone marrow activity: β = 0.20, p = 0.01) and subclinical CVD (VI: β = 0.31, p < 0.001; NCB: β = 0.27, p < 0.001) The AmygA−CVD association was in part mediated by HMPA (VI: 20.9%, NCB: 36.7%). Following 1 year of PSO treatment in those with severe disease, improvement in skin disease was accompanied by a reduction in AmygA, bone marrow activity, and VI, with no progression of NCB. Conclusions: In PSO, a chronic inflammatory disease state, AmygA, which is a manifestation of chronic stress, substantially contributes to the risk of subclinical CVD. Additional studies that use psychometric measures of stress are required to explore therapeutic impact.
AB - Objectives: This study hypothesized that there is an association between chronic stress (as indexed by resting amygdalar activity [AmygA]), hematopoietic system activity (HMPA), and subclinical cardiovascular indexes (aortic vascular inflammation [VI] and noncalcified coronary plaque burden [NCB]) in psoriasis (PSO). The study also hypothesized that treatment of PSO would improve these parameters. Background: PSO is a stress-related chronic inflammatory condition that is associated with increased prevalence of subclinical cardiovascular disease (CVD). In individuals without PSO, stress has been linked to CVD through a serial biological pathway that involves the amygdala, hematopoietic tissues, and atherosclerotic plaques. Methods: A total of 164 consecutive patients with PSO and 47 healthy volunteers underwent 18-fluorodeoxyglucose positron emission tomography/computed tomography scans for assessment of AmygA, HMPA, and VI, as well as coronary computed tomography angiography scans for quantifying NCB. Furthermore, a consecutive subset of 30 patients with severe PSO (Psoriasis Area Severity Index Score >10) were followed at 1 year to assess the relationship between skin disease improvement and AmygA, HMPA, VI, and NCB. Results: The PSO cohort was middle-aged (mean age: 50 years), had low cardiovascular risk (Framingham risk score: median: 3) and had mild to moderate PSO activity (median Psoriasis Area Severity Index Score: 5.6). AmygA was higher in patients with PSO compared to volunteer participants. AmygA was associated with HMPA (bone marrow activity: β = 0.20, p = 0.01) and subclinical CVD (VI: β = 0.31, p < 0.001; NCB: β = 0.27, p < 0.001) The AmygA−CVD association was in part mediated by HMPA (VI: 20.9%, NCB: 36.7%). Following 1 year of PSO treatment in those with severe disease, improvement in skin disease was accompanied by a reduction in AmygA, bone marrow activity, and VI, with no progression of NCB. Conclusions: In PSO, a chronic inflammatory disease state, AmygA, which is a manifestation of chronic stress, substantially contributes to the risk of subclinical CVD. Additional studies that use psychometric measures of stress are required to explore therapeutic impact.
KW - amygdala
KW - atherosclerosis
KW - inflammation
KW - psoriasis
KW - stress
UR - http://www.scopus.com/inward/record.url?scp=85078109593&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2018.08.038
DO - 10.1016/j.jcmg.2018.08.038
M3 - Article
C2 - 30448131
AN - SCOPUS:85078109593
SN - 1936-878X
VL - 13
SP - 465
EP - 477
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 2
ER -