Atherogenic Lipoprotein Burden, Metabolic Stress and Immune Activation Associated with Coronary Atherosclerosis in Patients with Psoriasis

Psoriasis is a chronic inflammatory disease associated with an increased cardiovascular risk (CVR). The mechanisms linking psoriasis to coronary atherosclerosis have not yet been fully elucidated. A dynamic interplay between metabolic disturbances, immune mechanisms, and elevated atherogenic lipoprotein particles may contribute to the accelerated development of atherosclerosis. Patients with psoriasis (<i>n</i> = 104) without known coronary artery disease underwent coronary computed tomography angiography (CCTA) to detect subclinical coronary atherosclerosis. Clinical data, metabolic parameters and indices, lipid fractions including remnant cholesterol, and immunological markers (immunoglobulin A- IgA) were analyzed. Associations with CT-confirmed coronary stenosis were assessed using univariate and multivariate logistic regression models. Patients with coronary atherosclerosis exhibited a more adverse metabolic and lipid profile. Remnant cholesterol emerged as a strong independent predictor of coronary stenosis. Elevated IgA levels were associated with the presence of coronary atherosclerosis, suggesting a potential role of immune activation that extends beyond general systemic inflammation. Longer duration of psoriasis correlated with the presence of coronary atherosclerosis, highlighting the importance of cumulative inflammatory burden. Our findings indicate that subclinical coronary atherosclerosis in patients with psoriasis is closely associated with an immuno-metabolic risk profile encompassing atherogenic lipoprotein fractions and immune activation. These results underscore the need for a broader approach to cardiovascular risk assessment in this population, extending beyond the evaluation of traditional cardiovascular risk factors alone.