The relationship between systemic inflammation and increased left ventricular mass is partly mediated by noncalcified coronary artery disease burden in psoriasis

Wunan Zhou; Meron Teklu; Vy Bui; Grigory A Manyak; Promita Kapoor; Amit K Dey; Alexander V Sorokin; Nidhi Patel; Heather L Teague; Martin P Playford; Julie Erb-Alvarez; Justin A Rodante; Andrew Keel; Sujata M Shanbhag; Li-Yueh Hsu; David A Bluemke; Marcus Y Chen; Marcus Carlsson; Nehal N Mehta

doi:10.1016/j.ajpc.2021.100211

The relationship between systemic inflammation and increased left ventricular mass is partly mediated by noncalcified coronary artery disease burden in psoriasis

Am J Prev Cardiol. 2021 May 30:7:100211. doi: 10.1016/j.ajpc.2021.100211. eCollection 2021 Sep.

Authors

Wunan Zhou¹, Meron Teklu¹, Vy Bui¹, Grigory A Manyak¹, Promita Kapoor¹, Amit K Dey¹, Alexander V Sorokin¹, Nidhi Patel¹, Heather L Teague¹, Martin P Playford¹, Julie Erb-Alvarez¹, Justin A Rodante¹, Andrew Keel¹, Sujata M Shanbhag¹, Li-Yueh Hsu², David A Bluemke³, Marcus Y Chen¹, Marcus Carlsson¹, Nehal N Mehta¹

Affiliations

¹ National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States.
² Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
³ Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.

Abstract

Objective: Increased left ventricular (LV) mass is an important precursor to heart failure. Inflammation plays an important role in increasing LV mass. However, the contribution of subclinical coronary artery disease (CAD) to the inflammation-LV mass relationship is unknown. In subjects with psoriasis, a chronic inflammatory skin disease, we evaluated if systemic inflammation assessed by plasma glycoprotein A (GlycA) associated with LV mass measured on coronary CT angiography (CCTA). Additionally, we analyzed whether this relationship was mediated by early CAD assessed as noncalcified coronary burden (NCB).

Methods: We performed an observational longitudinal study of 213 subjects with psoriasis free of known cardiovascular disease, 189 of whom were followed over one year. All participants had GlycA measurements by nuclear magnetic resonance spectroscopy and LV mass and NCB quantified by CCTA.

Results: The cohort had a mean age of 50.3 (±12.9) years and 59% were male. There was moderate psoriasis severity and low cardiovascular risk. LV mass increased by GlycA tertiles [1st tertile:24.6 g/m^2.7(3.8), 2nd tertile:25.5 g/m^2.7(3.8), 3rd tertile:27.7 g/m^2.7(5.5), p<0.001]. Both GlycA (β=0.24, p = 0.001) and NCB (β=0.50, p<0.001) associated with LV mass in models adjusted for age, sex, hypertension, hypertension therapy, lipid therapy, biologic therapy for psoriasis, waist:hip ratio, psoriasis disease duration and severity. In multivariable-adjusted mediation analyses, NCB accounted for 32% of the GlycA-LV mass relationship. Finally, over one year, change in NCB independently associated with change in LV mass (β=0.25, p = 0.002).

Conclusions: Both systemic inflammation and coronary artery NCB were associated with LV mass beyond cardiovascular risk factors in psoriasis. Furthermore, a substantial proportion of the inflammatory-LV mass relationship was mediated by NCB. These findings underscore the possible contribution of early coronary artery disease to the relationship between systemic inflammation and LV mass.

Keywords: CCTA, cardiac computed tomography angiography; Cardiac computed tomography angiography; GlycA, glycoprotein A; HDL-C, high-density lipoprotein cholesterol; Inflammation; LDL-C, low- density lipoprotein cholesterol; LV, left ventricular; Left ventricular mass; NCB, noncalcified coronary burden; Noncalcified coronary burden; hs-CRP, high sensitivity-C reactive protein.

Published by Elsevier B.V.