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Introduction: Psoriasis is a chronic inflammatory skin disease associated with accelerated development of asymptomatic coronary artery disease (CAD) by coronary computed tomography angiography (CCTA). Allostatic load score is a multidimensional measure related to chronic stress which incorporates cardiovascular, metabolic and inflammatory indices. To better understand the physiologic impact of chronic stress in psoriasis, we studied the association between allostatic load score and subclinical CAD. Hypothesis: We hypothesized that allostatic load score would associate with coronary artery disease burden beyond traditional risk factors in an ongoing psoriasis cohort study. Methods: Consecutive psoriasis patients (n=275) underwent CCTA for assessment of coronary artery disease burden (QAngio, Medis). Allostatic load score was determined using established methods (see Table 1 footnote). The association between coronary artery disease burden and allostatic load score was characterized by multivariable regression (STATA 12). Results: Psoriasis patients were middle-aged, predominantly male and white, with low cardiovascular risk by Framingham risk score and moderate-severe psoriasis severity (Table 1) . Allostatic load score associated with total coronary burden (β=0.39; p Conclusions: Allostatic load score positively associated with both total and non-calcified coronary artery burden beyond traditional risk factors, suggesting multisystem physiologic dysregulation related to chronic stress may drive subclinical atherosclerosis in psoriasis. Efforts to understand stress effects and its reduction are critical in this population at high-risk for cardiovascular disease.

Introduction: Psoriasis (PSO) is a chronic inflammatory condition associated with accelerated atherosclerosis and increased risk of myocardial infarction in part mediated through high visceral adipose tissue (VAT) volume. VAT has been shown to be associated with increased coronary burden; however, the relationship with prevalent coronary plaque in PSO has not been explored. Hypothesis: We hypothesized that VAT would associate with coronary plaque in PSO beyond traditional risk factors. Methods: A total of 164 consecutive PSO patients underwent coronary computed tomography angiography (CCTA) as part of a large cohort study to assess presence of coronary plaque. Low-dose CT was utilized to quantify VAT and subcutaneous adipose tissue (SAT) volume from the level of the diaphragm to the pubic symphysis. Logistic regression was used to assess the association between the presence of coronary plaque and the ratio of VAT-to-total adiposity in adjusted models (STATA 12). Results: The cohort was middle-aged, predominantly male, relatively low CV risk by FRS and mild to moderate PSO (Table 1). Patients with increased VAT-to-total adiposity, had significantly increased coronary plaque presence (70% (45 of 65) vs. 31% (31 of 99), p Conclusions: Having higher VAT was associated with higher prevalence of coronary plaque independent of total adiposity and cardiovascular risk factors. These findings suggest VAT contributes to coronary plaque in psoriasis and that weight loss efforts may improve outcomes in this high-risk population.

Background: Psoriasis, a chronic inflammatory disease, is associated with accelerated vascular inflammation (VI) by FDG PET/CT and increased cardiometabolic dysfunction, including adipose tissue dysregulation. Both visceral and subcutaneous adipose volume are associated with sub-clinical aortic VI as well as future cardiovascular events, however, the relationship of adipose inflammation (assessed as adipose FDG uptake) with sub-clinical aortic VI has never been characterized in psoriasis. Methods: 104 consecutive biologic naïve psoriasis patients underwent FDG PET/CT scans to measure VI and adipose FDG uptake, represented as target-to-background ratio (TBR) and standardized uptake value (SUV) respectively. After identification of anatomical location (vertebral level T10), a single 3D-volume region of interest with a fixed volume (4.0 cm 3 ) was placed in the subcutaneous adipose to measure FDG uptake as standardized uptake value (SUV) using a dedicated software (OsiriX MD, Geneva, Switzerland). Results: The cohort was middle-aged, predominantly male, low CV risk by Framingham risk score and mild-moderate psoriasis. Adipose FDG uptake significantly associated with skin disease severity as well as aortic VI even beyond traditional risk factors (β=0.33, p=0.001 and β=0.24, p=0.014 respectively). Additionally, adipose FDG uptake mediated the association between psoriasis skin disease severity and aortic VI accounting for 23% of the total effect (Figure). Conclusions: Our study demonstrated that adipose inflammation is positively associated with psoriasis severity as well as aortic VI. Moreover, adipose inflammation also mediated the relationship between skin disease severity and aortic VI, suggesting that it may contribute to the potential link between psoriasis and CV disease. However, larger studies are needed to confirm our findings.