1
|
Shah JT, Shah KT, Mazori DR, Caplan AS, Hejazi E, Garshick MS, Femia AN. Cardiovascular comorbidities are associated with dermatomyositis: A cross-sectional study in the All of Us Research Program. J Am Acad Dermatol 2024; 90:1013-1016. [PMID: 38160810 PMCID: PMC11015981 DOI: 10.1016/j.jaad.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Jill T Shah
- NYU Grossman School of Medicine, New York, New York
| | - Keya T Shah
- Department of Medicine, NYU Langone Hospital-Long Island, Mineola, New York
| | - Daniel R Mazori
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Avrom S Caplan
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Emily Hejazi
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Michael S Garshick
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; Center for the Prevention of Cardiovascular Disease, The Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, New York, New York
| | - Alisa N Femia
- NYU Grossman School of Medicine, New York, New York; The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York.
| |
Collapse
|
2
|
Zhang RS, Weber BN, Araiza-Garaygordobil D, Garshick MS. Colchicine for the Prevention of Cardiovascular Disease: Potential Global Implementation. Curr Cardiol Rep 2024:10.1007/s11886-024-02049-y. [PMID: 38573553 DOI: 10.1007/s11886-024-02049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Targeting traditional cardiovascular risk factors is effective in reducing recurrent cardiovascular events, yet the presence of residual cardiovascular risk due to underlying systemic inflammation is a largely unaddressed opportunity. This review aims to comprehensively assess the evolving role of colchicine as a therapeutic approach targeting residual inflammatory risk in the context of those with coronary artery disease (CAD). RECENT FINDINGS Inflammation plays a significant role in promoting atherosclerosis, and targeting anti-inflammatory pathways has the potential to decrease cardiovascular events. Low-dose colchicine (0.5 mg/day orally), when added to guideline-directed medical care for CAD, safely decreases major adverse cardiovascular events (MACE) by 31% in stable atherosclerosis patients and 23% in those after recent myocardial infarctions. Meta-analyses of recent randomized control trials further support both the efficacy and safety of colchicine, particularly when added to other standard cardiovascular therapies, including statin therapy. The European Society of Cardiology and other national guidelines endorse the use of low-dose colchicine in patients across the spectrum of CAD. Recently, colchicine was FDA-approved in the United States as the first anti-inflammatory therapy for the reduction of cardiovascular events. In a period of a rising incidence of CAD across the globe, colchicine represents a unique opportunity to decrease MACE due to its large magnitude of benefits and general affordability. However, challenges with drug interactions must be addressed, especially in those regions where HIV, hepatitis, and tuberculosis are prevalent. Colchicine is safe and effective at reducing cardiovascular events across a broad spectrum of coronary syndromes. The ability to simultaneously target traditional risk factors and mitigate residual inflammatory risk marks a substantial advancement in cardiovascular prevention strategies, heralding a new era in the global battle against CAD.
Collapse
Affiliation(s)
- Robert S Zhang
- Leon H. Charney Division of Cardiology and Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Brittany N Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Michael S Garshick
- Leon H. Charney Division of Cardiology and Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, NY, 10016, USA.
| |
Collapse
|
3
|
Hamo CE, Schlamp F, Drenkova K, Jindal M, Fadzan M, Akinlonu A, Goldberg I, Garshick MS, Berger JS. Burden of cardiometabolic risk factors and vascular health. Am Heart J 2024; 269:201-204. [PMID: 38199832 PMCID: PMC10922119 DOI: 10.1016/j.ahj.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/25/2023] [Accepted: 11/04/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Cardiometabolic risk factors diabetes, obesity, and hypertension are highly prevalent and contribute to increased cardiovascular disease (CVD). Endothelial dysfunction precedes CVD development. The current study aimed to investigate the EC transcriptome among individuals with varying degree of cardiometabolic risk. METHODS Adult participants without CVD and various degrees of cardiometabolic risk factor burden (hypertension, diabetes, obesity) were included. Participants underwent brachial vein EC harvesting followed by RNA sequencing. To evaluate the association between cardiometabolic comorbidity burden and outcome transcripts we performed linear regression with multivariable models, adjusting for age, sex, and race/ethnicity. RESULTS A total of 18 individuals were included in the present analysis (mean age 47 ± 14, 44% female, and 61% White adults). Endothelial cell RNA sequencing revealed 588 differentially expressed transcripts (p-adj <0.05) with excellent discrimination in unsupervised hierarchical clustering analysis. Gene ontology enrichment analysis revealed upregulated pathways associated with T-cell activation (NES = 2.22, p<0.001), leukocyte differentiation (NES= 2.16, p<0.001), leukocyte migration (NES= 2.12, p<0.001), regulation of cell-cell adhesion (NES= 1.91, p=0.006). Downregulated pathways of interest included endothelial cell proliferation (NES= -1.68, p=0.03) and response to interleukin-1 (NES= -1.61, p=0.04). Upregulated genes included VCAM1, CEACAM1, ADAM 17, and CD99L2, all with a log-2-fold change >3 and p-adj <0.05. These genes demonstrated a graded increase in mean normalized counts with increasing number of risk factors. CONCLUSIONS We demonstrate a proinflammatory and pro-adhesive EC transcriptome associated with increased cardiometabolic risk factor burden offering insight into a potential mechanism linking these risk factors with the development of CVD.
Collapse
Affiliation(s)
- Carine E Hamo
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, NY; Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY.
| | - Florencia Schlamp
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| | - Kamelia Drenkova
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| | - Manila Jindal
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| | - Maja Fadzan
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| | - Adedoyin Akinlonu
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| | - Ira Goldberg
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, NY; Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| | - Michael S Garshick
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, NY; Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| | - Jeffrey S Berger
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, NY; Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, NY
| |
Collapse
|
4
|
Song WB, Garshick MS, Barbieri JS, Shin DB, Báez S, Papadopoulos M, Neopaney A, Fitzsimmons R, Kalb RE, Mease PJ, Craig ET, Koplin J, Takeshita J, Chiesa Fuxench ZC, Armstrong AW, Mehta NN, Beidas RS, Ogdie AR, Gelfand JM. A Care Coordination Model to Prevent Cardiovascular Events in Patients with Psoriatic Disease: A Multicenter Pilot Study. J Invest Dermatol 2024:S0022-202X(23)03196-2. [PMID: 38184142 DOI: 10.1016/j.jid.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/08/2024]
Affiliation(s)
- William B Song
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael S Garshick
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA; Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suzette Báez
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryte Papadopoulos
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aakriti Neopaney
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert E Kalb
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Philip J Mease
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ethan T Craig
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joelle Koplin
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zelma C Chiesa Fuxench
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - April W Armstrong
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Nehal N Mehta
- Division of Cardiology, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexis R Ogdie
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
5
|
Ingrassia JP, Maqsood MH, Gelfand JM, Weber BN, Bangalore S, Lo Sicco KI, Garshick MS. Cardiovascular and Venous Thromboembolic Risk With JAK Inhibitors in Immune-Mediated Inflammatory Skin Diseases: A Systematic Review and Meta-Analysis. JAMA Dermatol 2024; 160:28-36. [PMID: 37910098 PMCID: PMC10620674 DOI: 10.1001/jamadermatol.2023.4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/28/2023] [Indexed: 11/03/2023]
Abstract
Importance Janus kinase (JAK) inhibitors are an effective treatment option for patients with certain skin-related conditions, such as atopic dermatitis, alopecia areata, and vitiligo, but there is a current US Food and Drug Administration (FDA) boxed warning label for oral and topical JAK inhibitors regarding increased risk of major adverse cardiovascular events (MACE), venous thromboembolism (VTE), serious infections, malignant neoplasm, and death. However, this boxed warning was precipitated by results of the Oral Rheumatoid Arthritis Trial (ORAL) Surveillance study, which only included patients with rheumatoid arthritis, and the same association may not be observed in dermatologic conditions. Objective To determine the risk of all-cause mortality, MACE, and VTE with JAK inhibitors in patients with dermatologic conditions. Data Sources PubMed and ClinicalTrials.gov were searched from database inception to April 1, 2023. Study Selection This review included phase 3 randomized clinical trials with a placebo/active comparator group of JAK inhibitors used for a dermatologic indication with FDA approval or pending approval or with European Union or Japanese approval. Studies without a comparison group, case reports, observational studies, and review articles were excluded. Data Extraction and Synthesis This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Adverse events using odds ratios (ORs) and 95% CIs were calculated using a random-effects model and the DerSimonian-Laird method. Studies were screened, data abstracted, and quality assessed by 2 independent authors. The protocol was prospectively registered with PROSPERO. Main Outcomes and Measures Primary outcomes were a composite of adjudicated MACE and all-cause mortality, and VTE. Results The analysis included 35 randomized clinical trials with 20 651 patients (mean [SD] age, 38.5 [10.1] years; male, 54%) and a mean (SD) follow-up time of 4.9 (2.68) months. Findings did not show a significant difference between JAK inhibitors and placebo/active comparator in composite MACE and all-cause mortality (OR, 0.83; 95% CI, 0.44-1.57) or VTE (OR, 0.52; 95% CI, 0.26-1.04). Conclusions and Relevance In this systematic review and meta-analysis, use of JAK inhibitors was not associated with increased risk of all-cause mortality, MACE, and VTE compared to the placebo/active comparator groups. Additional trials with long-term follow-up are needed to better understand the safety risks of JAK inhibitors used for dermatologic indications.
Collapse
Affiliation(s)
- Jenne P. Ingrassia
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, NYU Langone Health, New York
- New York Medical College, Valhalla, New York
| | - Muhammad Haisum Maqsood
- DeBakey Heart and Vascular Center, Department of Cardiology, Methodist Hospital, Houston, Texas
| | - Joel M. Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Sripal Bangalore
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, NYU Langone Health, New York
| | - Kristen I. Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, NYU Langone Health, New York
| | - Michael S. Garshick
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, NYU Langone Health, New York
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York
| |
Collapse
|
6
|
Kawano Y, Pabón MA, Feldman CH, Cuddy S, Lilly LS, Garshick MS, Weber B. Evaluation and management of pericarditis in rheumatic diseases. J Cardiovasc Pharmacol 2023:00005344-990000000-00236. [PMID: 37815280 PMCID: PMC11001789 DOI: 10.1097/fjc.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT This review summarizes the evaluation for underlying rheumatic conditions in patients presenting with acute pericarditis, treatment considerations for specific rheumatic conditions, and the role of imaging in diagnosis and monitoring. Pericarditis may be one of the initial presentations of a rheumatic disease or identified in a patient with known rheumatic disease. There is also growing evidence for using anti-inflammatory and immunosuppressive agents for treating recurrent pericarditis, which can overlap with the treatment of rheumatic diseases.
Collapse
Affiliation(s)
- Yumeko Kawano
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Maria A. Pabón
- Heart and Vascular Center, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sarah Cuddy
- Heart and Vascular Center, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Leonard S. Lilly
- Heart and Vascular Center, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Brittany Weber
- Heart and Vascular Center, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
7
|
Wang S, Shin DB, Bhutani T, Garshick MS, Gelfand JM. Cardiovascular Health in People with Psoriasis: A Population-Based Study in the United States. J Invest Dermatol 2023; 143:2075-2078. [PMID: 37088279 DOI: 10.1016/j.jid.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Sonia Wang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Michael S Garshick
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health System, New York, New York, USA; Ronald O. Perelman Department of Dermatology, New York University Langone Health System, New York, New York, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
8
|
Shah JT, Shah KT, Femia AN, Lo Sicco KI, Merola JF, Weber B, Garshick MS. Cardiovascular Risk Management in Patients Treated with JAK Inhibitors. J Cardiovasc Pharmacol 2023:00005344-990000000-00213. [PMID: 37566808 PMCID: PMC10913172 DOI: 10.1097/fjc.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
ABSTRACT The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway plays a critical role in the pathogenesis of many immune-mediated inflammatory diseases (IMIDs). Although Janus kinase inhibitors (JAKi) are an effective treatment for several IMIDs, they have come under scrutiny as a class due to a potential risk of venous thromboembolism (VTE) and cardiovascular (CV) events, specifically noted with the oral JAKi, tofacitinib, as reported in the ORAL Surveillance Trial of a high CV risk rheumatoid arthritis population. This trial resulted in a black box warning from the Food and Drug Administration and European Medicines Agency regarding risk of VTE and CV events that was extended across several types of JAKi (including topical ruxolitinib) when treating IMIDs, leading to considerable controversy. Included is an up-to-date review of the current and rapidly evolving literature on CV risk in patients with IMIDs on JAKi therapy, including identification of potential risk factors for future VTE and CV events on JAKi therapy. We suggest a comprehensive, multimodal, and systematic approach for evaluation of CV risk in patients considering taking JAKi and emphasize that cardiologists play an important role in risk stratification and mitigation for patients with high CV risk factors or on long-term JAKi therapies.
Collapse
Affiliation(s)
- Jill T. Shah
- New York University Grossman School of Medicine, New York, NY
| | - Keya T. Shah
- Department of Medicine, NYU Langone Long Island Hospital, Mineola, NY
| | - Alisa N. Femia
- New York University Grossman School of Medicine, New York, NY
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, NY
| | - Kristen I. Lo Sicco
- New York University Grossman School of Medicine, New York, NY
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, NY
| | - Joseph F. Merola
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Brittany Weber
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Michael S. Garshick
- New York University Grossman School of Medicine, New York, NY
- The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, NY
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY
| |
Collapse
|
9
|
Garshick MS, Barrett TJ, Cornwell MG, Drenkova K, Garelik J, Weber BN, Schlamp F, Rockman C, Ruggles KV, Reynolds HR, Berger JS. An inflammatory transcriptomic signature in psoriasis associates with future cardiovascular events. J Eur Acad Dermatol Venereol 2023. [PMID: 36924033 DOI: 10.1111/jdv.19049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Psoriasis is an inflammatory skin disease associated with increased cardiovascular (CV) risk, whose pathogenesis is not fully known. OBJECTIVE We identified a transcriptomic signature in psoriasis and investigated its association with prevalent and future risk of a CV event to understand the connection between psoriasis and CV disease (CVD). METHODS Psoriasis patients (n = 37) with a history of moderate-severe skin disease without CVD and 11 matched controls underwent whole blood RNA sequencing. This transcriptomic signature in psoriasis versus controls was evaluated in two CVD cohorts: Women referred for cardiac catheterization with (n = 76) versus without (n = 97) myocardial infarction (MI), and patients with peripheral artery disease (n = 106) followed over 2.5 years for major adverse CV or limb events (MACLE). The association between genes differentially expressed in psoriasis and prevalent and incident CV events was assed. RESULTS In psoriasis, median age was 44 (IQR; 34-51) years, 49% male and ACC/AHA ASCVD Risk Score of 1.0% (0.6-3.4) with no significant difference versus controls. The median psoriasis area and severity index score (PASI) was 4.0 (IQR 2.9-8.2) with 36% on biologic therapy. Overall, 247 whole blood genes were upregulated and 228 downregulated in psoriasis versus controls (p < 0.05), and 1302 genes positively and 1244 genes negatively correlated with PASI (p < 0.05). Seventy-three genes overlapped between psoriasis prevalence and PASI with key regulators identified as IL-6, IL-1β and interferon gamma. In the CVD cohorts, 50 of 73 genes (68%) identified in psoriasis associated with prevalent MI, and 29 (40%) with incident MACLE. Key regulator transcripts identified in psoriasis and CVD cohorts included SOCS3, BCL3, OSM, PIM2, PIM3 and STAT5A. CONCLUSIONS A whole blood transcriptomic signature of psoriasis diagnosis and severity associated with prevalent MI and incident MACLE. These data have implications for better understanding the link between psoriasis, systemic inflammation and CVD.
Collapse
Affiliation(s)
- Michael S Garshick
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, New York, USA
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, New York, USA
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York City, New York, USA
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, New York, USA
| | - MacIntosh G Cornwell
- Division of Precision Medicine, New York University School of Medicine, New York City, New York, USA
- Institute for Systems Genetics, New York University School of Medicine, New York City, New York, USA
| | - Kamelia Drenkova
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, New York, USA
| | - Jessica Garelik
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York City, New York, USA
| | - Brittany N Weber
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Florencia Schlamp
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, New York, USA
| | - Caron Rockman
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York City, New York, USA
| | - Kelly V Ruggles
- Division of Precision Medicine, New York University School of Medicine, New York City, New York, USA
- Institute for Systems Genetics, New York University School of Medicine, New York City, New York, USA
| | - Harmony R Reynolds
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, New York, USA
| | - Jeffrey S Berger
- Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, New York, USA
- Leon H. Charney Division of Cardiology, Department of Medicine, Cardiovascular Research Center, New York University School of Medicine, New York City, New York, USA
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York City, New York, USA
| |
Collapse
|
10
|
Gelfand JM, Wang S, Garshick MS. Autoimmune diseases and cardiovascular risk. Trends Mol Med 2022; 28:1025-1027. [PMID: 36357282 DOI: 10.1016/j.molmed.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
There are more than 80 different autoimmune diseases which collectively affect 4-8% of the world's population. In a recent study published in Lancet, Conrad et al. found that 19 autoimmune diseases are associated with a composite of cardiovascular disease (CVD). Inflammation promotes atherosclerotic CVD with psoriasis and rheumatoid arthritis recognized as CVD risk enhancers. New strategies are needed to identify and mitigate the impact of chronic inflammation on CVD-related morbidity and mortality.
Collapse
Affiliation(s)
- Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - Sonia Wang
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Michael S Garshick
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA; Ronald O. Perelman Department of Dermatology, New York University Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA
| |
Collapse
|
11
|
Marcantoni E, Garshick MS, Schwartz T, Ratnapala N, Cambria M, Dann R, O’Brien M, Heguy A, Berger JS. Antiplatelet Effects of Clopidogrel Vs Aspirin in Virologically Controlled HIV: A Randomized Controlled Trial. JACC Basic Transl Sci 2022; 7:1086-1097. [PMID: 36687270 PMCID: PMC9849466 DOI: 10.1016/j.jacbts.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Patients with HIV exhibit platelet activation and increased risk of cardiovascular disease, the prevention of which is not fully known. Fifty-five HIV-positive patients were randomized to clopidogrel, aspirin, or no-treatment for 14 days, and the platelet phenotype and ability to induce endothelial inflammation assessed. Clopidogrel as opposed to aspirin and no-treatment reduced platelet activation (P-selectin and PAC-1 expression). Compared with baseline, platelet-induced proinflammatory transcript expression of cultured endothelial cells were reduced in those assigned to clopidogrel, with no change in the aspirin and no-treatment arms. In HIV, clinical trials of clopidogrel to prevent cardiovascular disease are warranted. (Antiplatelet Therapy in HIV; NCT02559414).
Collapse
Affiliation(s)
- Emanuela Marcantoni
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Michael S. Garshick
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA,Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Tamar Schwartz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Nicole Ratnapala
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Matthew Cambria
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York, USA
| | - Rebecca Dann
- New York Medical College, Valhalla, New York, USA
| | - Meagan O’Brien
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Adriana Heguy
- Genome Technology Center, New York University School of Medicine, New York, New York, USA
| | - Jeffrey S. Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA,Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA,Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York, USA,Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York, USA,Address for correspondence: Dr Jeffrey S. Berger, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 435 East 30th Street, 7th Floor, New York, New York 10016, USA. @plateletdoc
| |
Collapse
|
12
|
Koschitzky M, Navrazhina K, Garshick MS, Gonzalez J, Han J, Garcet S, Krueger JG. Ustekinumab reduces serum protein levels associated with cardiovascular risk in psoriasis vulgaris. Exp Dermatol 2022; 31:1341-1351. [PMID: 35474520 PMCID: PMC9869081 DOI: 10.1111/exd.14582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 01/26/2023]
Abstract
Psoriasis increases the risk of cardiovascular disease (CVD). Biomarkers for cardiovascular (CV) risk stratification in psoriasis are lacking, and the effects of psoriasis biologics on CV risk reduction remain unclear. The goal of this study was to identify biomarkers of CV risk in psoriasis blood that are reduced by ustekinumab. We quantified 276 inflammatory and CV-related serum proteins with Olink's multiplex assay in 10 psoriasis patients (vs. 18 healthy controls) and after 12 weeks of ustekinumab treatment. For each protein down-regulated after treatment, the literature was reviewed for studies assessing the protein's association with CVD. Data were collected from each study to calculate CV risk thresholds for each protein, which were compared with protein levels in psoriasis patients before and after treatment. Our results showed that 43 out of 276 proteins were down-regulated after treatment, 25 of which were initially up-regulated at baseline (vs. controls, all p-values ≤0.1). 8 down-regulated proteins were initially elevated above thresholds associated with enhanced CV risk in the literature (myeloperoxidase, C-X-C motif chemokine 10, E-selectin, interleukin-6, cystatin B, von Willebrand factor, tumor necrosis factor receptor 1 and N-terminal prohormone brain natriuretic peptide). Treatment lowered these proteins to below their risk thresholds, except for IL-6, which was lowered but remained at its risk threshold despite successful psoriasis skin treatment. In summary, 12 weeks of ustekinumab treatment reduced serum proteins present at levels associated with CV risk in psoriasis patients. Further studies can evaluate these proteins as potential ustekinumab-modulated biomarkers of CV risk in psoriasis and the impact of ustekinumab on CV risk reduction.
Collapse
Affiliation(s)
- Merav Koschitzky
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell University, New York, New York, USA
| | - Michael S. Garshick
- Center for the Prevention of Cardiovascular Disease and Leon H. Charney Division of Cardiology, Department of Medicine, Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Juana Gonzalez
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Joseph Han
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - James G. Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| |
Collapse
|
13
|
Maqsood MH, Weber BN, Haberman RH, Lo Sicco KI, Bangalore S, Garshick MS. Cardiovascular and Venous Thromboembolic Risk With Janus Kinase Inhibitors in
Immune‐Mediated
Inflammatory Diseases: A Systematic Review and
Meta‐Analysis
of Randomized Trials. ACR Open Rheumatol 2022; 4:912-922. [PMID: 35903881 PMCID: PMC9555201 DOI: 10.1002/acr2.11479] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
|
14
|
Garshick MS, Drenkova K, Barrett TJ, Schlamp F, Fisher EA, Katz S, Jelic S, Neimann AL, Scher JU, Krueger J, Berger JS. A Randomized Open-Label Clinical Trial of Lipid-Lowering Therapy in Psoriasis to Reduce Vascular Endothelial Inflammation. J Invest Dermatol 2022; 142:1749-1752.e4. [PMID: 34808233 PMCID: PMC9893130 DOI: 10.1016/j.jid.2021.07.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, NYU Langone Health, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York, USA; Cardiovascular Research Center, NYU Langone Health, New York, New York, USA.
| | - Kamelia Drenkova
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York, USA; Cardiovascular Research Center, NYU Langone Health, New York, New York, USA
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York, USA; Cardiovascular Research Center, NYU Langone Health, New York, New York, USA
| | - Florencia Schlamp
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York, USA; Cardiovascular Research Center, NYU Langone Health, New York, New York, USA
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, NYU Langone Health, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York, USA; Cardiovascular Research Center, NYU Langone Health, New York, New York, USA
| | - Stuart Katz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Sanja Jelic
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrea L Neimann
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York, USA
| | - Jose U Scher
- Psoriatic Arthritis Center, Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, New York, USA
| | - James Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, NYU Langone Health, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York, USA; Cardiovascular Research Center, NYU Langone Health, New York, New York, USA; Division of Hematology & Medical Oncology, Department of Medicine, NYU Langone Health, New York, New York, USA; Division of Vascular & Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, New York, USA
| |
Collapse
|
15
|
Garshick MS, Block R, Drenkova K, Tawil M, James G, Brenna JT. Statin therapy upregulates arachidonic acid status via enhanced endogenous synthesis in patients with plaque psoriasis. Prostaglandins Leukot Essent Fatty Acids 2022; 180:102428. [PMID: 35490599 PMCID: PMC9870621 DOI: 10.1016/j.plefa.2022.102428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 01/26/2023]
Abstract
Circulating fatty acids (FA) may be important in the psoriatic pro-inflammatory phenotype. FADS1 converts linoleic acid (LA) to arachidonic acid (AA), a precursor to potent signaling molecules. HMG-CoA reductase inhibitors (statins) increase FADS1/2 expression in vitro. Psoriasis patients (42 ± 14 years/age, 47% male) were randomized to 40 mg of atorvastatin (n = 20) or nothing (n = 10) for two weeks and plasma FA measured pre and post treatment. After treatment, LDL-C was 44% lower in the statin compared to the no-treatment group. Statins increased FADS1/2 expression, and lowered LA 12% (33% - > 29%, p<0.001) and raised AA 14% (7.7% - > 9.0%, p<0.01) with no change in the no-treatment group. In psoriasis, statins enhance AA and decrease LA, consistent with the action of enhanced FADS expression in vivo. Therapies intended to blunt the effects of AA on platelet aggregation, such as aspirin or omega-3 fatty acids, may require dose adjustment when co-administered with atorvastatin. NCT: NCT03228017.
Collapse
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, NYU Langone Health, United States; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, United States; Cardiovascular Research Center, NYU Langone Health, United States.
| | - Robert Block
- Department of Public Health Sciences and Cardiology Division, Department of Medicine, University of Rochester, United States
| | - Kamelia Drenkova
- Cardiovascular Research Center, NYU Langone Health, United States
| | - Michael Tawil
- Cardiovascular Research Center, NYU Langone Health, United States
| | - Genevieve James
- Dell Pediatric Research Institute and Dept of Nutrition, University of Texas at Austin, United States
| | - J Thomas Brenna
- Dell Pediatric Research Institute and Dept of Nutrition, University of Texas at Austin, United States
| |
Collapse
|
16
|
Jindal M, Garshick MS, Schlamp F, Barrett T, Giannarelli C, Newman J, Fadzan M, Heguy A, Fisher EA, Goldberg IJ, Berger JS. Abstract 227: Statins Decrease Endothelial Cell Inflammation On Top Of Maximal Cholesterol Reduction: Findings From The American Heart Association Strategically Focused Cardiometabolic Health And Type 2 Diabetes Mellitus Research Network. Arterioscler Thromb Vasc Biol 2022. [DOI: 10.1161/atvb.42.suppl_1.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background:
Dyslipidemia induces a proinflammatory endothelium and vascular dysfunction. Lipid lowering therapy (LLT) consistently reduces cardiovascular (CV) events. Clinical studies suggest that statin-based LLT has pleiotropic anti-inflammatory effects beyond cholesterol reduction. However, the impact of statins or ezetimibe on top of potent cholesterol reduction is unknown. Thus, on a background of PCSK9 inhibition (with evolocumab), we analyzed the effect of LLT with atorvastatin or ezetimibe on the endothelium using a novel direct brachial vein (BV) endothelial cell (EC) harvesting technique.
Methods:
CHORD (CHOlesterol lowering and Residual Risk in Diabetes) is an ongoing, prospective study designed to evaluate the effect of maximal LLT on CV risk. Subjects with LDL-C >100mg/dl were treated with evolocumab (140mg/2 weeks) and either atorvastatin (80mg/day) or ezetimibe (10mg/day) for 30 days. In a subset of participants, EC harvesting was performed by inserting a J-wire into the BV, and ECs were isolated and analyzed using next generation RNA sequencing.
Results:
Among 20 participants (11 atorvastatin, 9 ezetimibe) undergoing EC RNASeq, median LDL-C (130 mg/dl, IQR [110, 147]) decreased by 75% [67, 81] on background PCSK9 inhibition with no significant difference in 30-day LDL-C between atorvastatin (27 mg/dl [20, 32]) and ezetimibe (41 mg/dl [26, 53]) groups (p=0.07). Following cholesterol reduction, 850 genes were upregulated and 2468 were downregulated (p<0.05) with downregulation of eNOS, Endothelin-1, and Senescence pathways by canonical pathway analysis. When stratified by LLT, patients receiving atorvastatin had a significant decrease in inflammation and senescence pathways compared to patients receiving ezetimibe (Figure).
Conclusions:
Robust lipid lowering with PCSK9 inhibition plus statins, as opposed to ezetimibe has anti-inflammatory effects and suggests a preferred strategy to improve the endothelium and reduce CV risk.
Collapse
|
17
|
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, NYU Langone Health, New York, New York
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, NYU Langone Health, New York, New York
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York
- Division of Hematology, Department of Medicine, NYU Langone Health, New York, New York
- Division of Vascular Surgery, Department of Surgery, NYU Langone Health, New York, New York
| |
Collapse
|
18
|
Garshick MS, Rosenthal PB, Luttrell-Williams E, Cronstein BN, Berger JS. Ticagrelor added to methotrexate improves rheumatoid arthritis disease severity. Rheumatology (Oxford) 2021; 60:5473-5475. [PMID: 34142122 PMCID: PMC8783537 DOI: 10.1093/rheumatology/keab481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/06/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine
| | | | | | - Bruce N Cronstein
- Division of Rheumatology, Department of Medicine
- Division of Translational Medicine
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
19
|
Wang VA, Zilli Vieira CL, Garshick E, Schwartz JD, Garshick MS, Vokonas P, Koutrakis P. Solar Activity Is Associated With Diastolic and Systolic Blood Pressure in Elderly Adults. J Am Heart Assoc 2021; 10:e021006. [PMID: 34713707 PMCID: PMC8751821 DOI: 10.1161/jaha.120.021006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Since solar activity and related geomagnetic disturbances modulate autonomic nervous system activity, we hypothesized that these events would be associated with blood pressure (BP). Methods and Results We studied 675 elderly men from the Normative Aging Study (Boston, MA) with 1949 BP measurements between 2000 and 2017. Mixed‐effects regression models were used to investigate the association of average 1‐day (ie, day of BP measurement) to 28‐day interplanetary magnetic field intensity, sunspot number, and a dichotomized measure of global geomagnetic activity (Kp index) in 4‐day increments with diastolic and systolic BP. We adjusted for meteorological conditions and other covariates associated with BP, and in additional models adjusted for ambient air pollutants (particulate matter with an aerodynamic diameter ≤2.5 µm, black carbon, and particle number) and ambient particle radioactivity. There were positive associations between interplanetary magnetic field, sunspot number, and Kp index and BP that were greatest with these exposures averaged over 16 through 28 days before BP measurement. An interquartile range increase of 16‐day interplanetary magnetic field and sunspot number and higher Kp index were associated with a 2.5 (95% CI, 1.7‒3.2), 2.8 (95% CI, 2.1‒3.4), and 1.7 (95% CI, 0.8‒2.5) mm Hg increase, respectively, for diastolic BP as well as a 2.1 (95% CI, 0.7‒3.6), 2.7 (95% CI, 1.5‒4.0), and 0.4 (95% CI, −1.2 to 2.1) mm Hg increase, respectively, for systolic BP. Associations remained after adjustment for ambient air pollutants and ambient particle radioactivity. Conclusions Solar activity and solar‐driven geomagnetic disturbances were positively associated with BP, suggesting that these natural phenomena influence BP in elderly men.
Collapse
Affiliation(s)
- Veronica A Wang
- Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA
| | | | - Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System Boston MA.,Channing Division of Network Medicine Department of Medicine Brigham and Women's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Joel D Schwartz
- Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA
| | - Michael S Garshick
- Department of Medicine Center for the Prevention of Cardiovascular Disease New York University School of Medicine New York NY.,Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY
| | - Pantel Vokonas
- VA Normative Aging Study Veterans Affairs Boston Healthcare System Boston MA.,Department of Medicine Boston University School of Medicine Boston MA
| | - Petros Koutrakis
- Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA
| |
Collapse
|
20
|
Ali T, Garshick MS, Saric M, Skolnick AH. Aortic closure signal length on doppler echocardiography differentiates aortic patient-prosthesis mismatch from prosthetic stenosis. J Clin Ultrasound 2021; 49:644-649. [PMID: 33665868 DOI: 10.1002/jcu.23002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/27/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to investigate the diagnostic potential of the aortic closure (A2) signal length on Doppler echocardiography in distinguishing aortic patient-prosthesis mismatch (PPM) from prosthetic stenosis among patients with elevated gradients over bioprosthetic valves. METHODS The A2 signal length was retrospectively measured for 150 patients with bioprosthetic aortic valves (50 with PPM, 50 with prosthetic stenosis, and 50 with normally functioning valves) from transthoracic echocardiograms performed at NYU Langone Health between 01/01/2012 and 08/01/2018. RESULTS Mean A2 signal length was shorter among patients with PPM (11.1 ms ± 5.2 ms), than among those with prosthetic stenosis (21.1 ms ± 6.0 ms), P < .001 and controls (21.7 ms ± 7.4 ms), P < .001. There was no difference in A2 signal length between prosthetic stenosis and controls. The A2 signal length yielded an AUC of 0.89 (95% CI 0.82-0.95) for predicting PPM over prosthetic stenosis. CONCLUSION Among patients with bioprosthetic aortic valves, the length of the A2 signal on Doppler echocardiography is shorter in PPM than in prosthetic stenosis and normally functioning valves. The A2 signal length may represent a novel metric to distinguish PPM from prosthetic stenosis.
Collapse
Affiliation(s)
- Thara Ali
- Department of Internal Medicine, New York University Langone Medical Center, New York City, New York, USA
| | - Michael S Garshick
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York City, New York, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York City, New York, USA
| | - Adam H Skolnick
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York City, New York, USA
| |
Collapse
|
21
|
Garshick MS, Nikain C, Tawil M, Pena S, Barrett TJ, Wu BG, Gao Z, Blaser MJ, Fisher EA. Reshaping of the gastrointestinal microbiome alters atherosclerotic plaque inflammation resolution in mice. Sci Rep 2021; 11:8966. [PMID: 33903700 PMCID: PMC8076321 DOI: 10.1038/s41598-021-88479-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/13/2021] [Indexed: 02/08/2023] Open
Abstract
Since alterations in the intestinal microbiota may induce systemic inflammation and polarization of macrophages to the M1 state, the microbiome role in atherosclerosis, an M1-driven disease, requires evaluation. We aimed to determine if antibiotic (Abx) induced alterations to the intestinal microbiota interferes with atherosclerotic plaque inflammation resolution after lipid-lowering in mice. Hyperlipidemic Apoe−/− mice were fed a western diet to develop aortic atherosclerosis with aortas then transplanted into normolipidemic wild-type (WT) mice to model clinically aggressive lipid management and promote atherosclerosis inflammation resolution. Gut microbial composition pre and post-transplant was altered via an enteral antibiotic or not. Post aortic transplant, after Abx treatment, while plaque size did not differ, compared to Apoe−/− mice, Abx– WT recipient mice had a 32% reduction in CD68-expressing cells (p = 0.02) vs. a non-significant 12% reduction in Abx+ WT mice. A trend toward an M1 plaque CD68-expresing cell phenotype was noted in Abx+ mice. By 16S rRNA sequence analysis, the Abx+ mice had reduced alpha diversity and increased Firmicutes/Bacteroidetes relative abundance ratio with a correlation between gut Firmicutes abundance and plaque CD68-expressing cell content (p < 0.05). These results indicate that in a murine atherosclerotic plaque inflammation resolution model, antibiotic-induced microbiome perturbation may blunt the effectiveness of lipid-lowering to reduce the content of plaque inflammatory CD68-expressing cells.
Collapse
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, USA.,Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Cyrus Nikain
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Stephanie Pena
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Benjamin G Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, USA.,Division of Pulmonary and Critical Care, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| | - Zhan Gao
- Center for Advanced Biotechnology and Medicine, Rutgers University, 679 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Martin J Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, 679 Hoes Lane West, Piscataway, NJ, 08854, USA.
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, USA. .,Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, USA. .,Marc and Ruti Bell Vascular Biology Program, Cardiovascular Research Center, New York University Langone Health, New York, USA.
| |
Collapse
|
22
|
Garshick MS, Ward NL, Krueger JG, Berger JS. Cardiovascular Risk in Patients With Psoriasis: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77:1670-1680. [PMID: 33795041 DOI: 10.1016/j.jacc.2021.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease that affects 2% to 3% of the U.S. population. The immune response in psoriasis includes enhanced activation of T cells and myeloid cells, platelet activation, and up-regulation of interferons, tumor necrosis factor-α, and interleukins (ILs) IL-23, IL-17, and IL-6, which are linked to vascular inflammation and atherosclerosis development. Patients with psoriasis are up to 50% more likely to develop cardiovascular disease (CV) disease, and this CV risk increases with skin severity. Major society guidelines now advocate incorporating a psoriasis diagnosis into CV risk prediction and prevention strategies. Although registry data suggest treatment targeting psoriasis skin disease reduces vascular inflammation and coronary plaque burden, and may reduce CV risk, randomized placebo-controlled trials are inconclusive to date. Further studies are required to define traditional CV risk factor goals, the optimal role of lipid-lowering and antiplatelet therapy, and targeted psoriasis therapies on CV risk.
Collapse
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease and Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA.
| | - Nicole L Ward
- Departments of Nutrition and Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York, USA
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease and Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York, USA
| |
Collapse
|
23
|
Elnabawi YA, Garshick MS, Tawil M, Barrett TJ, Fisher EA, Lo Sicco K, Neimann AL, Scher JU, Krueger J, Berger JS. CCL20 in psoriasis: A potential biomarker of disease severity, inflammation, and impaired vascular health. J Am Acad Dermatol 2020; 84:913-920. [PMID: 33259876 DOI: 10.1016/j.jaad.2020.10.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psoriasis is associated with increased cardiovascular risk that is not captured by traditional proinflammatory biomarkers. OBJECTIVE To investigate the relationship between Psoriasis Area and Severity Index, circulating proinflammatory biomarkers, and vascular health in psoriasis. METHODS In patients with psoriasis and in age and sex-matched controls, 273 proteins were analyzed with the Proseek Multiplex Cardiovascular disease reagents kit and Inflammatory reagents kit (Olink Bioscience), whereas vascular endothelial inflammation and health were measured via direct transcriptomic analysis of brachial vein endothelial cells. RESULTS In psoriasis, chemokine ligand 20 (CCL20), interleukin (IL) 6, and IL-17A were the top 3 circulating proinflammatory cytokines. Vascular endothelial inflammation correlated with CCL20 (r = 0.55; P < .001) and less so with IL-6 (r = 0.36; P = .04) and IL-17A (r = 0.29; P = .12). After adjustment for potential confounders, the association between CCL20 and vascular endothelial inflammation remained significant (β = 1.71; P = .02). In nested models, CCL20 added value (χ2 = 79.22; P < .001) to a model already incorporating the Psoriasis Area and Severity Index, Framingham risk, high-sensitivity C-reactive protein, Il-17A, and IL-6 (χ2 = 48.18; P < .001) in predicting vascular endothelial inflammation. LIMITATIONS Our study was observational and did not allow for causal inference in the relationship between CCL20 and cardiovascular risk. CONCLUSION We demonstrate that CCL20 expression has a strong association with vascular endothelial inflammation, reflects systemic inflammation, and may serve as a potential biomarker of impaired vascular health in psoriasis.
Collapse
Affiliation(s)
- Youssef A Elnabawi
- Department of Internal Medicine, New York University School of Medicine, New York, New York
| | - Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, New York; Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, New York; Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Kristen Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Andrea L Neimann
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jose U Scher
- Psoriatic Arthritis Center, Division of Rheumatology, New York University School of Medicine, New York, New York
| | - James Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, New York; Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York; Division of Hematology, New York University School of Medicine, New York, New York; Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York
| |
Collapse
|
24
|
Lin B, D Jaros B, A Grossi E, Saric M, S Garshick M, Donnino R. Prevalence and Risk Factors of Incomplete Surgical Closure of the Left Atrial Appendage on Follow-up Transesophageal Echocardiogram. J Atr Fibrillation 2020; 13:2357. [PMID: 34950308 DOI: 10.4022/jafib.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022]
Abstract
Objectives In patients with atrial fibrillation, incomplete left atrial appendage (LAA) closure is associated with an increased risk for cardio-embolic events compared to complete closure. In this study, we aimed to determine the prevalence and risk factors for incomplete surgical closure of the LAA in the modern surgical era. Methods Records of 74 patients with surgical LAA closure who underwent follow-up transesophageal echocardiogram for any reason between 2010 and 2016, were assessed for incomplete closure. Complete closure was defined by absence of Doppler or color flow between the left atrial appendage and the left atrial body in more than 2 orthogonal views. Results Surgical LAA closure was incomplete in 21 patients (28%) and complete in 53 patients (72%). All included cases were completed via oversewing method with a double layer of running suture with or without excision of the LAA. While no individual demographic, echocardiographic, or surgical feature was significantly different between groups, incomplete closure of the LAA was more prevalent in patients with two or more of the risk factors; female sex, hypertension, and hyperlipidemia (OR 5.1, 95%Cl 1.5-17). Conclusions A significant rate of incomplete surgical LAA closure still exists in the modern surgical era, and the presence of multiple risk factors associate an increased risk of incomplete closure.
Collapse
Affiliation(s)
- Billy Lin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brian D Jaros
- NYU School of Medicine, NYU Langone Health, New York City, New York
| | - Eugene A Grossi
- NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York City, New York
| | - Muhamed Saric
- NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Michael S Garshick
- Authors share senior authorship.,NYU School of Medicine, NYU Langone Health, New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Robert Donnino
- Authors share senior authorship.,NYU School of Medicine, NYU Langone Health, New York City, New York.,Veterans Affairs Medical Center, New York (Manhattan Campus), New York City, New York.,Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| |
Collapse
|
25
|
Kadosh BS, Garshick MS, Gaztanaga J, Moore KJ, Newman JD, Pillinger M, Ramasamy R, Reynolds HR, Shah B, Hochman J, Fishman GI, Katz SD. COVID-19 and the Heart and Vasculature: Novel Approaches to Reduce Virus-Induced Inflammation in Patients With Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2020; 40:2045-2053. [PMID: 32687400 PMCID: PMC7446967 DOI: 10.1161/atvbaha.120.314513] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge and opportunity for translational investigators to rapidly develop safe and effective therapeutic interventions. Greater risk of severe disease in COVID-19 patients with comorbid diabetes mellitus, obesity, and heart disease may be attributable to synergistic activation of vascular inflammation pathways associated with both COVID-19 and cardiometabolic disease. This mechanistic link provides a scientific framework for translational studies of drugs developed for treatment of cardiometabolic disease as novel therapeutic interventions to mitigate inflammation and improve outcomes in patients with COVID-19.
Collapse
Affiliation(s)
- Bernard S. Kadosh
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Michael S. Garshick
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Juan Gaztanaga
- Division of Internal Medicine, Department of Cardiology, NYU Winthrop Hospital, Mineola (J.G.)
| | - Kathryn J. Moore
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Jonathan D. Newman
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Michael Pillinger
- Department of Medicine, Division of Rheumatology, New York, NY (M.P.)
- VA New York Harbor Healthcare System, Department of Medicine (M.P., B.S.)
| | - Ravichandran Ramasamy
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Harmony R. Reynolds
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Binita Shah
- VA New York Harbor Healthcare System, Department of Medicine (M.P., B.S.)
| | - Judith Hochman
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Glenn I. Fishman
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| | - Stuart D. Katz
- From the Department of Medicine, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (B.S.K., M.S.G., K.J.M., J.D.N., R.R., H.R.R., J.H., G.I.F., S.D.K.)
| |
Collapse
|
26
|
Garshick MS, Baumer Y, Dey AK, Grattan R, Ng Q, Teague HL, Yu ZX, Chen MY, Tawil M, Barrett TJ, Underberg J, Fisher EA, Krueger J, Powell-Wiley TM, Playford MP, Berger JS, Mehta NN. Characterization of PCSK9 in the Blood and Skin of Psoriasis. J Invest Dermatol 2020; 141:308-315. [PMID: 32615123 DOI: 10.1016/j.jid.2020.05.115] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 12/30/2022]
Abstract
Mechanisms explaining the link between psoriasis, a proinflammatory condition, and cardiovascular disease are not fully known. PCSK9 is predominantly expressed in hepatocytes as a critical regulator of lipid metabolism, and clinical trials targeting PCSK9 reduce cardiovascular disease. Independent of its role in lipid metabolism, PCSK9 levels associate with endothelial dysfunction and predict cardiovascular events. We used two separate human psoriasis cohorts and the K14-Rac1V12-/+ murine model of psoriasis to investigate PCSK9 and cardiovascular risk in psoriasis. In both psoriasis cohorts (n = 88 and n = 20), PCSK9 levels were 20% and 13% higher than in age-, sex-, and cholesterol-matched controls, respectively (P < 0.05 for each comparison) and correlated with PASI (r = 0.43, P < 0.05). Despite no difference in hepatocyte expression, K14-Rac1V12-/+ mice demonstrated skin-specific PCSK9 staining, which was confirmed in human psoriatic lesional skin. In patients with psoriasis, PCSK9 levels correlated with impaired endothelial vascular health (e.g., early atherosclerosis, β = 4.5, P < 0.01) and log converted coronary artery calcium score (β = 0.30, P = 0.01), which remained significant after adjustment for Framingham risk, body mass index, and active biologic use. Taken together, these findings suggest, independent of cholesterol, an association between circulating PCSK9 and early as well as advanced stages of atherosclerosis in psoriasis.
Collapse
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Yvonne Baumer
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ryan Grattan
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Qimin Ng
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather L Teague
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zu-Xi Yu
- Pathology Core Facility, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Y Chen
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Tessa J Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - James Underberg
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - James Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York, USA
| | - Tiffany M Powell-Wiley
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martin P Playford
- Pathology Core Facility, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, New York, New York, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
| |
Collapse
|
27
|
Garshick MS, Tawil M, Barrett TJ, Salud-Gnilo CM, Eppler M, Lee A, Scher JU, Neimann AL, Jelic S, Mehta NN, Fisher EA, Krueger JG, Berger JS. Activated Platelets Induce Endothelial Cell Inflammatory Response in Psoriasis via COX-1. Arterioscler Thromb Vasc Biol 2020; 40:1340-1351. [PMID: 32131611 PMCID: PMC7180109 DOI: 10.1161/atvbaha.119.314008] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Patients with psoriasis have impaired vascular health and increased cardiovascular disease (CVD). Platelets are key players in the pathogenesis of vascular dysfunction in cardiovascular disease and represent therapeutic targets in cardiovascular prevention. The object of this study was to define the platelet phenotype and effector cell properties on vascular health in psoriasis and evaluate whether aspirin modulates the platelet-induced phenotype. Approach and Results: Platelets from psoriasis patients (n=45) exhibited increased platelet activation (relative to age- and gender-matched controls, n=18), which correlated with psoriasis skin severity. Isolated platelets from psoriasis patients demonstrated a 2- to 3-fold (P<0.01) increased adhesion to human aortic endothelial cells and induced proinflammatory transcriptional changes, including upregulation of IL 8 (interleukin 8), IL1β, and Cox (cyclooxygenase)-2 Platelet RNA sequencing revealed an interferon signature and elevated expression of COX-1, which correlated with psoriasis disease severity (r=0.83, P=0.01). In a randomized trial of patients with psoriasis, 2 weeks of 81 mg low-dose aspirin, a COX-1 inhibitor, reduced serum thromboxane (Tx) B2 and reduced brachial vein endothelial proinflammatory transcript expression >70% compared with the no-treatment group (P<0.01). Improvement in brachial vein endothelial cell inflammation significantly correlated with change in serum TxB2 (r=0.48, P=0.02). CONCLUSIONS In patients with psoriasis, platelets are activated and induce endothelial cell inflammation. Low-dose aspirin improved endothelial cell health in psoriasis via platelet COX-1 inhibition. These data demonstrate a previously unappreciated role of platelets in psoriasis and endothelial cell inflammation and suggests that aspirin may be effective in improving vascular health in patients with psoriasis. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03228017.
Collapse
Affiliation(s)
- Michael S. Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Michael Tawil
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Tessa J. Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | | | - Michael Eppler
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Angela Lee
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Jose U. Scher
- Psoriatic Arthritis Center, Division of Rheumatology, Department of Medicine, New York University School of Medicine
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Sanja Jelic
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Medical Center
| | - Nehal N. Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health
| | - Edward A. Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - James G. Krueger
- Psoriatic Arthritis Center, Division of Rheumatology, Department of Medicine, New York University School of Medicine
| | - Jeffrey S. Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
- Division of Hematology, Department of Medicine, New York University School of Medicine
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine
| |
Collapse
|
28
|
Garshick MS. Editorial commentary: Psoriasis, inflammation and cardiometabolic disease. Will we ever get to the heart of the matter? Trends Cardiovasc Med 2019; 30:479-480. [PMID: 31810858 DOI: 10.1016/j.tcm.2019.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, 435 East 30th Street, 7th Floor, New York, NY 10016, United States; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, United States.
| |
Collapse
|
29
|
Barrett TJ, Distel E, Murphy AJ, Hu J, Garshick MS, Ogando Y, Liu J, Vaisar T, Heinecke JW, Berger JS, Goldberg IJ, Fisher EA. Apolipoprotein AI) Promotes Atherosclerosis Regression in Diabetic Mice by Suppressing Myelopoiesis and Plaque Inflammation. Circulation 2019; 140:1170-1184. [PMID: 31567014 PMCID: PMC6777860 DOI: 10.1161/circulationaha.119.039476] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite robust cholesterol lowering, cardiovascular disease risk remains increased in patients with diabetes mellitus. Consistent with this, diabetes mellitus impairs atherosclerosis regression after cholesterol lowering in humans and mice. In mice, this is attributed in part to hyperglycemia-induced monocytosis, which increases monocyte entry into plaques despite cholesterol lowering. In addition, diabetes mellitus skews plaque macrophages toward an atherogenic inflammatory M1 phenotype instead of toward the atherosclerosis-resolving M2 state typical with cholesterol lowering. Functional high-density lipoprotein (HDL), typically low in patients with diabetes mellitus, reduces monocyte precursor proliferation in murine bone marrow and has anti-inflammatory effects on human and murine macrophages. Our study aimed to test whether raising functional HDL levels in diabetic mice prevents monocytosis, reduces the quantity and inflammation of plaque macrophages, and enhances atherosclerosis regression after cholesterol lowering. METHODS Aortic arches containing plaques developed in Ldlr-/- mice were transplanted into either wild-type, diabetic wild-type, or diabetic mice transgenic for human apolipoprotein AI, which have elevated functional HDL. Recipient mice all had low levels of low-density lipoprotein cholesterol to promote plaque regression. After 2 weeks, plaques in recipient mouse aortic grafts were examined. RESULTS Diabetic wild-type mice had impaired atherosclerosis regression, which was normalized by raising HDL levels. This benefit was linked to suppressed hyperglycemia-driven myelopoiesis, monocytosis, and neutrophilia. Increased HDL improved cholesterol efflux from bone marrow progenitors, suppressing their proliferation and monocyte and neutrophil production capacity. In addition to reducing circulating monocytes available for recruitment into plaques, in the diabetic milieu, HDL suppressed the general recruitability of monocytes to inflammatory sites and promoted plaque macrophage polarization to the M2, atherosclerosis-resolving state. There was also a decrease in plaque neutrophil extracellular traps, which are atherogenic and increased by diabetes mellitus. CONCLUSIONS Raising apolipoprotein AI and functional levels of HDL promotes multiple favorable changes in the production of monocytes and neutrophils and in the inflammatory environment of atherosclerotic plaques of diabetic mice after cholesterol lowering and may represent a novel approach to reduce cardiovascular disease risk in people with diabetes mellitus.
Collapse
Affiliation(s)
- Tessa J. Barrett
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA
| | - Emilie Distel
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA
| | - Andrew J. Murphy
- Haematopoiesis and Leukocyte Biology, Division of Immunometabolism, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Department of Immunology, Monash University, Melbourne, VIC 3004, Australia
| | - Jiyuan Hu
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, NY 10016, USA
| | - Michael S. Garshick
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA
| | - Yoscar Ogando
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA
| | - Jianhua Liu
- Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Tomas Vaisar
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle
| | - Jay W. Heinecke
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle
| | - Jeffrey S. Berger
- Department of Medicine, Divisions of Cardiology and Hematology, Department of Surgery, Division of Vascular Surgery, New York University School of Medicine, New York, NY 10016, USA
| | - Ira J. Goldberg
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York University School of Medicine, New York, NY 10016, USA
| | - Edward A. Fisher
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA
- Department of Microbiology and Immunology, New York University School of Medicine, New York, NY 10016, USA
| |
Collapse
|
30
|
Garshick MS, Vaidean G, Nikain CA, Chen Y, Smilowitz NR, Berger JS. Sex differences in the prevalence of vascular disease and risk factors in young hospitalized patients with psoriasis. Int J Womens Dermatol 2019; 5:251-255. [PMID: 31700981 PMCID: PMC6831767 DOI: 10.1016/j.ijwd.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 01/05/2023] Open
Abstract
Background Psoriasis is an inflammatory skin disease associated with atherosclerotic cardiovascular disease (ASCVD) risk factors and vascular disease. The relative impact of psoriasis on vascular disease is the strongest in young patients with psoriasis, yet data are lacking on how sex differences influence cardiovascular risk factors and vascular disease in these patients. Objective This observational study aimed to identify the burden of cardiovascular risk factors and vascular disease in patients with psoriasis and to explore whether this burden is different between men and women age < 35 years. Methods Young (age ≥ 20 and < 35 years) hospitalized patients with psoriasis from the United States National Inpatient Sample were compared with those matched patients without psoriasis. Vascular disease was defined as ASCVD and/or venous thromboembolic disease. Multivariable logistic regression was used to determine the associations between psoriasis, sex, ASCVD risk factors, and vascular disease. Results Overall, patients with psoriasis (n = 18,353) were more often obese (16% vs. 6%); smokers (31% vs. 17%); and diagnosed with diabetes mellitus (10% vs. 6%), hypertension (16% vs. 8%), hyperlipidemia (6% vs. 2%), ASCVD (2.2% vs. 1.6%), and deep vein thrombosis (6% vs. 4%; all p < .001) compared with patients without psoriasis (n = 55,059; matched by age, sex, and race). When stratified by sex, women with psoriasis were more likely to have multiple cardiovascular risk factors and ASCVD (odds ratio: 2.6; 95% confidence interval [2.1-3.1]) compared with men with psoriasis (odds ratio: 1.2; 95% confidence interval [0.9-1.4]; interaction p < .01). The association between psoriasis and ASCVD in women remained unchanged after multivariable adjustment for traditional cardiovascular risk factors. Conclusion Psoriasis was associated with cardiovascular disease and risk factors in young hospitalized patients, with stronger associations among women than among men.
Collapse
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, New York.,Leon H. Charney Division of Cardiology, New York University School of Medicine, New York City, New York
| | - Georgeta Vaidean
- Fairleigh Dickinson University School of Pharmacy & Health Sciences, Florham Park, New Jersey
| | - Cyrus A Nikain
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York City, New York
| | - Yu Chen
- Department of Population Health and Environmental Health, New York University School of Medicine, New York City, New York
| | - Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York City, New York
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, New York.,Leon H. Charney Division of Cardiology, New York University School of Medicine, New York City, New York
| |
Collapse
|
31
|
Garshick MS, Vaidean GD, Vani A, Underberg JA, Newman JD, Berger JS, Fisher EA, Gianos E. Cardiovascular Risk Factor Control and Lifestyle Factors in Young to Middle-Aged Adults with Newly Diagnosed Obstructive Coronary Artery Disease. Cardiology 2019; 142:83-90. [PMID: 31079098 DOI: 10.1159/000498891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND While progress in the prevention of cardiovascular disease (CVD) has been noted over the past several decades, there are still those who develop CVD earlier in life than others. OBJECTIVE We investigated traditional and lifestyle CVD risk factors in young to middle-aged patients compared to older ones with obstructive coronary artery disease (CAD). METHODS A retrospective analysis of patients with a new diagnosis of obstructive CAD undergoing coronary intervention was performed. Young to middle-aged patients were defined as those in the youngest quartile (n = 281, mean age 50 ± 6 years, 81% male) compared to the other three older quartiles combined (n = 799, mean age 69 ± 7.5 years, 71% male). Obstructive CAD was determined by angiography. RESULTS Young to middle-aged patients compared to older ones were more likely to be male (p < 0.01), smokers (21 vs. 9%, p < 0.001), and have a higher body mass index (31 ± 6 vs. 29 ± 6 kg/m2, p < 0.001). Younger patients were less likely to eat fruits, vegetables, and fish and had fewer controlled CVD risk factors (2.7 ± 1.2 vs. 3.0 ± 1.0, p < 0.001). Compared to older patients, higher levels of psychological stress (aOR 1.6, 95% CI 1.1-2.4), financial stress (aOR 1.8, 95% CI 1.3-2.5), and low functional capacity (aOR 3.3, 95% CI 2.4-4.5) were noted in the young to middle-aged population as well. CONCLUSION Lifestyle in addition to traditional CVD risk factors should be taken into account when evaluating risk for development of CVD in a younger population.
Collapse
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA,
| | - Georgeta D Vaidean
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA.,Fairleigh Dickinson University School of Pharmacy and Health Sciences, Florham Park, New Jersey, USA
| | - Anish Vani
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - James A Underberg
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Jonathan D Newman
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Eugenia Gianos
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| |
Collapse
|
32
|
Garshick MS, Barrett T, Wechter T, Azarchi S, Scher J, Neimann A, Katz S, Fuentes-Duculan J, Cannizzaro MV, Jelic S, Fisher EA, Krueger JG, Berger JS. Inflammasome Signaling and Impaired Vascular Health in Psoriasis. Arterioscler Thromb Vasc Biol 2019; 39:787-798. [PMID: 30760013 PMCID: PMC6436998 DOI: 10.1161/atvbaha.118.312246] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective- Psoriasis is an inflammatory skin disease which heightens the risk of cardiovascular disease. This study directly investigated vascular endothelial health and systemically altered pathways in psoriasis and matched controls. Approach and Results- Twenty patients (mean age, 40 years; 50% male) with active psoriasis and 10 age-, sex-matched controls were recruited. To investigate systemically alerted pathways, a deep sequencing omics approach was applied, including unbiased blood transcriptomic and targeted proteomic analysis. Vascular endothelial health was assessed by transcriptomic profiling of endothelial cells obtained from the brachial veins of recruited participants. Blood transcriptomic profiling identified inflammasome signaling as the highest differentially expressed canonical pathway ( Z score 1.6; P=1×10-7) including upregulation of CASP5 and interleukin ( IL) -1β. Proteomic panels revealed IL-6 as a top differentially expressed cytokine in psoriasis with pathway analysis highlighting IL-1β ( Z score 3.7; P=1.02×10-23) as an upstream activator of the observed upregulated proteins. Direct profiling of harvested brachial vein endothelial cells demonstrated inflammatory transcript (eg, IL-1β, CXCL10, VCAM-1, IL-8, CXCL1, Lymphotoxin beta, ICAM-1, COX-2, and CCL3) upregulation between psoriasis versus controls. A linear relationship was seen between differentially expressed endothelial inflammatory transcripts and psoriasis disease severity. IL-6 levels correlated with inflammatory endothelial cell transcripts and whole blood inflammasome-associated transcripts, including CASP5 and IL-1β. Conclusions- An unbiased sequencing approach demonstrated the inflammasome as the most differentially altered pathway in psoriasis versus controls. Inflammasome signaling correlated with psoriasis disease severity, circulating IL-6, and proinflammatory endothelial transcripts. These findings help better explain the heightened risk of cardiovascular disease in psoriasis. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT03228017.
Collapse
Affiliation(s)
- Michael S. Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine;,Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Tessa Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | | | - Sarah Azarchi
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Jose Scher
- Psoriatic Arthritis Center, Division of Rheumatology, Department of Medicine, New York University School of Medicine
| | - Andrea Neimann
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine
| | - Stuart Katz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | | | | | - Sanja Jelic
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Medical Center
| | - Edward A. Fisher
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine;,Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - James G. Krueger
- Laboratory for Investigative Dermatology, Rockefeller University
| | - Jeffrey S. Berger
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine;,Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine;,Division of Vascular Surgery, Department of Surgery, New York University School of Medicine
| |
Collapse
|
33
|
Garshick MS, Nikain C, Tawil M, Wu B, Gao Z, Blaser M, Fisher E. THE CONTRIBUTION OF GASTROINTESTINAL MICROBIOME ALTERATIONS TO ATHEROSCLEROTIC PLAQUE REGRESSION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Teague HL, Varghese NJ, Tsoi LC, Dey AK, Garshick MS, Silverman JI, Baumer Y, Harrington CL, Stempinski E, Elnabawi YA, Dagur PK, Cui K, Tunc I, Seifuddin F, Joshi AA, Stansky E, Purmalek MM, Rodante JA, Keel A, Aridi TZ, Carmona-Rivera C, Sanda GE, Chen MY, Pirooznia M, McCoy JP, Gelfand JM, Zhao K, Gudjonsson JE, Playford MP, Kaplan MJ, Berger JS, Mehta NN. Neutrophil Subsets, Platelets, and Vascular Disease in Psoriasis. ACTA ACUST UNITED AC 2019; 4:1-14. [PMID: 30847414 PMCID: PMC6390681 DOI: 10.1016/j.jacbts.2018.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
LDGs are a subset of neutrophils that were elevated in psoriasis and associated with the severity of disease. In psoriasis, LDGs associated with noncalcified coronary plaque burden beyond cardiovascular risk factors and in vitro, induced endothelial cell damage. Compared to normal-density granulocyte neutrophils, platelet-associated biological pathways were upregulated in LDGs, suggesting enhanced platelet adherence to the LDG surface. LDGs co-localized with platelets in circulation, and the LDG-platelet interaction associated more strongly with non-calcified coronary burden by coronary CTA compared to LDGs alone.
Psoriasis is an inflammatory skin disease associated with increased cardiovascular risk and serves as a reliable model to study inflammatory atherogenesis. Because neutrophils are implicated in atherosclerosis development, this study reports that the interaction among low-density granulocytes, a subset of neutrophils, and platelets is associated with a noncalcified coronary plaque burden assessed by coronary computed tomography angiography. Because early atherosclerotic noncalcified burden can lead to fatal myocardial infarction, the low-density granulocyte−platelet interaction may play a crucial target for clinical intervention.
Collapse
Key Words
- CCTA, coronary computed tomography angiography
- CVD, cardiovascular disease
- FDR, false discovery rate
- HAoEC, human aortic endothelial cell
- LDG, low-density granulocyte
- MI, myocardial infarction
- NCB, noncalcified coronary plaque burden
- NDG, normal-density granulocyte
- NET, neutrophil extracellular trap
- PASI, psoriasis area severity index
- SLE, systemic lupus erythematosus
- TB, total coronary plaque burden
- cardiovascular disease
- low-density granulocytes
- neutrophils
- platelets
- psoriasis
Collapse
Affiliation(s)
- Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nevin J Varghese
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael S Garshick
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York
| | - Joanna I Silverman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Yvonne Baumer
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Charlotte L Harrington
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Erin Stempinski
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Pradeep K Dagur
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kairong Cui
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ilker Tunc
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Fayaz Seifuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Elena Stansky
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Monica M Purmalek
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Tarek Z Aridi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Gregory E Sanda
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mehdi Pirooznia
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - J Philip McCoy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Keji Zhao
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey S Berger
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
35
|
Garshick MS, Mulliken J, Schoenfeld M, Riedy K, Guo Y, Zhong J, Dodson JA, Saric M, Skolnick AH. Average e' velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation. Echocardiography 2018; 35:1939-1946. [PMID: 30315597 PMCID: PMC10723071 DOI: 10.1111/echo.14148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/21/2018] [Accepted: 09/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Studies have demonstrated the value of transthoracic echocardiogram (TTE) diastolic parameters in predicting left atrial appendage (LAA) thrombus; however, these studies have been small. We aim to clarify the relationship between TTE diastolic parameters, in particular average e', and LAA thrombus or sludge. METHODS A case-control review was conducted of subjects with non-valvular atrial fibrillation (n = 2263) who had undergone TEE (transesophageal echocardiogram) and had a TTE within 1 year of TEE. Cases of LAA sludge or thrombus were matched to controls by age, sex, left ventricular ejection fraction (LVEF), and anticoagulation status. RESULTS Forty-three subjects (mean age 73 ± 12, 65% male, LVEF 47%, 44% on anticoagulation) with LAA sludge or thrombus were identified. Compared to matched controls, average TTE e' (7.3 ± 2.1 cm/s vs 8.7 ± 2.1 cm/s, P < 0.001) and the E:e' ratio (15 ± 7 cm/s vs 12 ± 5 cm/s; P = 0.005) were significant predictors of LAA sludge or thrombus. Average TTE e' value of >11 cm/s had 100% sensitivity for ruling out LAA sludge or thrombus. CONCLUSION In individuals with atrial fibrillation, average e' >11 cm/s on TTE is a promising independent predictor of the absence of LAA sludge or thrombus on TEE.
Collapse
Affiliation(s)
- Michael S. Garshick
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Jennifer Mulliken
- Department of Internal Medicine, NYU Health Langone, New York City, New York
| | - Matthew Schoenfeld
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Katherine Riedy
- Department of Internal Medicine, NYU Health Langone, New York City, New York
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York City, New York
| | - Judy Zhong
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York City, New York
| | - John A. Dodson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| | - Adam H. Skolnick
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York City, New York
| |
Collapse
|
36
|
Garshick MS, Barrett T, Scher J, Neimann A, Katz S, Li X, Jelic S, Krueger J, Berger JS. Abstract 256: The Direct Characterization of Endothelial Inflammation in Patients with Psoriasis. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Psoriasis, an inflammatory autoimmune disease, increases the risk of cardiovascular disease (CVD). Active psoriatic disease is linked to systemic vascular inflammation, yet how this contributes to CVD is unknown. Using
in vivo
and
ex-vivo
measures of the vascular endothelium our study investigates the vascular health of psoriasis patients to better understand the mechanism(s) that predispose psoriatics to CVD.
Methods:
Ten patients with active psoriasis (average age 46 years, 50% male (5 of 10), 6% [3.5% – 90%] body surface area involvement) were compared to age- and sex- matched controls.
In vivo
vascular endothelial function was assessed by brachial artery reactivity testing (BART, %) with high resolution ultrasonography. Venous endothelial cells were collected from the brachial vein using guidewires inserted through an angiocatheter and isolated with magnetic beads directed against CD146. Following collection, endothelial RNA was isolated, converted to cDNA and inflammatory gene profiling performed by RT-qPCR with Taqman probes and primers.
Results:
Transcriptomic profiling of venous endothelial cells revealed upregulation of genes associated with inflammatory cytokines and chemokines (
lymphotoxin beta
[2.5 - fold],
CCL3
[3.5 - fold], and
IL-1
β
[2.8 - fold], P < 0.05 for all) and genes related to intracellular adhesion and inflammation (
ICAM1
[2.3 – fold] and
COX-2
[1.4 – fold], P < 0.05 for both) in psoriatics vs. controls. Unexpectedly, endothelial nitric oxide synthase (eNOS) and phosphorylated eNOS (higher levels indicate healthy endothelial NO production) were upregulated (2 - 3 fold) in psoriatics vs. controls (p = 0.24, p = 0.14 respectively). BART was also higher in psoriatics when compared to controls (7.1 ± 1% vs. 3.9 ± 2.7%, P = 0.03).
Conclusion:
This cross-sectional study is the first to directly examine the vascular endothelium of psoriatic patients. Compared to controls, active psoriatic disease was associated with upregulation of cytokines, chemokines and genes regulating intracellular adhesion as well as increased expression of eNOS, and increased BART. These findings suggest potential mechanisms to explain the increased prevalence of atherosclerosis and CVD risk seen in those with psoriasis.
Collapse
Affiliation(s)
| | | | | | | | | | - Xuan Li
- Rockefeller Univ, New York, NY
| | | | | | | |
Collapse
|
37
|
Charytan DM, Garg P, Varma M, Garshick MS, Jeon C, Mauri L. Angiographic characteristics of coronary arterial segments progressing to myocardial infarction in patients with and without chronic kidney disease. Clin Exp Nephrol 2012; 17:232-9. [PMID: 22926696 DOI: 10.1007/s10157-012-0682-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Individuals with chronic kidney disease (CKD) have high rates of myocardial infarction (MI), but whether the nature of coronary lesions susceptible to plaque rupture is altered and whether the high rate of MI is related to a greater burden of atherosclerotic lesions in individuals with CKD is uncertain. METHODS We used quantitative coronary angiography to assess atherosclerotic plaque location and characteristics at baseline and at the time of MI in 62 patients with and without CKD. Univariate and multivariable conditional logistic regression models were used to assess whether the association between pre-MI angiographic findings and MI differs in individuals with and without CKD. RESULTS The risk of MI rose as the distance from the coronary ostium decreased both in patients with CKD (odds ratio per 10 mm 0.92 [95 % CI 0.87-0.99]) and in those without CKD (odds ratio 0.83 [95 % CI 0.75-0.93]). Although tighter degrees of coronary stenosis were associated with increased risks of MI in patients with and without CKD, the majority of MIs (70.9 % in patients with CKD and 89.5 % in those without CKD) occurred in segments with <50 % diameter stenosis at baseline. CONCLUSIONS The characteristics of lesions progressing to MI are similar in individuals with and without CKD and the majority of events occur in areas with <50 % stenosis at baseline. Given the high burden of non-stenotic lesions in patients with CKD, an interventional strategy aimed solely at sites with high-grade stenosis is unlikely to markedly reduce the risk of MI in patients with CKD.
Collapse
Affiliation(s)
- David M Charytan
- Renal Division and Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA 02120, USA.
| | | | | | | | | | | |
Collapse
|