Cholesterol efflux capacity is associated with lipoprotein size and vascular health in mild to moderate psoriasis

Alexander R Berg; Rylee F Petrole; Haiou Li; Alexander V Sorokin; Alvaro Gonzalez-Cantero; Martin P Playford; Nehal N Mehta; Heather L Teague

doi:10.3389/fcvm.2023.1041457

Cholesterol efflux capacity is associated with lipoprotein size and vascular health in mild to moderate psoriasis

Front Cardiovasc Med. 2023 Feb 20:10:1041457. doi: 10.3389/fcvm.2023.1041457. eCollection 2023.

Authors

Alexander R Berg¹, Rylee F Petrole¹, Haiou Li¹, Alexander V Sorokin¹, Alvaro Gonzalez-Cantero^{2

3}, Martin P Playford¹, Nehal N Mehta¹, Heather L Teague¹

Affiliations

¹ National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, United States.
² Dermatology Service, Hospital Universitario Ramón y Cajal, Medicine Department, Faculty of Medicine, Universidad de Alcalá, IRYCIS, Madrid, Spain.
³ Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.

Abstract

Background and objective: Psoriasis is a systemic inflammatory condition with poor cholesterol transport measured by cholesterol efflux capacity (CEC) that is associated with a heightened risk of cardiovascular disease (CVD). In psoriasis patients, we sought to characterize the lipoprotein profile by size using a novel nuclear magnetic resonance algorithm in patients with low CEC compared to normal CEC.

Methods: Lipoprotein profile was assessed using the novel nuclear magnetic resonance LipoProfile-4 deconvolution algorithm. Aortic vascular inflammation (VI) and non-calcified burden (NCB) were characterized via positron emission tomography-computed tomography and coronary computed tomography angiography. To understand the relationship between lipoprotein size and markers of subclinical atherosclerosis, linear regression models controlling for confounders were constructed.

Results: Psoriasis patients with low CEC had higher more severe psoriasis (p = 0.04), VI (p = 0.04) and NCB (p = 0.001), concomitant with smaller high-density lipoprotein (HDL) (p < 0.001) and low-density lipoprotein (LDL) particles (p < 0.001). In adjusted models HDL size (β = -0.19; p = 0.02) and LDL size (β = -0.31; p < 0.001) associated with VI and NCB. Lastly, HDL size strongly associated with LDL size in fully adjusted models (β = -0.27; p < 0.001).

Conclusion: These findings demonstrate that in psoriasis, low CEC associates with a lipoprotein profile comprised of smaller HDL and LDL particles which correlates with vascular health and may be driving early onset atherogenesis. Further, these results demonstrate a relationship between HDL and LDL size and provide novel insights into the complexities of HDL and LDL as biomarkers of vascular health.

Keywords: atheroscelrosis; cholesterol efflux; high density lipoprotein; lipoprotein size; low density lipoprotein; psoriasis.