Association of neutrophil-to-lymphocyte ratio with non-calcified coronary artery burden in psoriasis: Findings from an observational cohort study

Amit K Dey; Heather L Teague; Nicholas H Adamstein; Justin A Rodante; Martin P Playford; Marcus Y Chen; David A Bluemke; Joel M Gelfand; Paul M Ridker; Nehal N Mehta

doi:10.1016/j.jcct.2020.12.006

Association of neutrophil-to-lymphocyte ratio with non-calcified coronary artery burden in psoriasis: Findings from an observational cohort study

J Cardiovasc Comput Tomogr. 2021 Jul-Aug;15(4):372-379. doi: 10.1016/j.jcct.2020.12.006. Epub 2020 Dec 28.

Affiliations

¹ National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
² Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, MA, USA.
³ University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁴ Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA.
⁵ National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. Electronic address: nehal.mehta@nih.gov.

PMID: 33390348
DOI: 10.1016/j.jcct.2020.12.006

Abstract

Background: Inflammation in the form of elevated high-sensitivity c-reactive protein (hs-CRP) has been shown to be critical in the development of atherothrombosis. Psoriasis, a chronic inflammatory skin disease, is associated with high systemic-inflammation, elevated neutrophil-to-lymphocyte ratio (NLR) and accelerated non-calcified coronary artery burden (NCB) by coronary computed tomography angiography (CCTA). We hypothesized that NLR would associate with early, rupture-prone atherosclerosis assessed as NCB independent of hs-CRP.

Methods: 316 consecutive psoriasis participants were recruited with 233 having one-year follow-up as part of a prospective, observational cohort study design. CCTA scans were performed to assess NCB in all three major epicardial coronary arteries.

Results: Patients with above average NLR (>mean: 2.29 ± 1.21) were older (mean ± SD; 52.0 ± 12.8 vs. 47.9 ± 12.6, p = 0.002), had higher hs-CRP (med. IQR: 2.3 (0.9-7.3) vs. 1.4 (0.7-3.2), p = 0.001) and had higher NCB (mean ± SD; 1.21 ± 0.58 vs. 1.13 ± 0.49, p = 0.018) when compared to patients with below average NLR. NLR associated with psoriasis area severity index score (β = 0.14, p = 0.017), hs-CRP (β = 0.16, p = 0.005), as well as NCB independent of traditional risk factors, body mass index, statin use and hs-CRP (β = 0.08, p = 0.009). One year of biologic therapy for psoriasis was associated with a reduction in NLR (-14.5%, p < 0.001), and this change in NLR associated with change in NCB in fully adjusted models and beyond hs-CRP (β = 0.17, p = 0.002).

Conclusion: NLR associated with psoriasis severity, hs-CRP and NCB at baseline. Biologic therapy reduced NLR over time and this change in NLR associated with the change in NCB at one-year. Taken together, these findings suggest that NLR may capture psoriasis patients at higher risk of NCB due to residual inflammation not fully captured by hs-CRP.

Keywords: Coronary artery disease; High-sensitivity C-reactive protein; Inflammation; Neutrophil-to-lymphocyte ratio; Psoriasis.

Published by Elsevier Inc.

Publication types

Observational Study

MeSH terms

Biomarkers
C-Reactive Protein
Cohort Studies
Coronary Artery Disease* / diagnostic imaging
Humans
Lymphocytes
Neutrophils
Predictive Value of Tests
Prospective Studies
Psoriasis* / diagnostic imaging

Substances

Biomarkers
C-Reactive Protein