High-sensitivity C-reactive protein is associated with altered cardiac structure and function in psoriasis: The PSOCADIA study

BACKGROUND: High sensitivity C-reactive protein (hsCRP) is a biomarker of systemic inflammation that may be associated with cardiovascular risk in psoriasis. We assessed the relationship between hsCRP levels and cardiac structure and function in a large cross-sectional cohort study of individuals with psoriasis.

METHODS: Adults with psoriasis underwent hsCRP testing and transthoracic echocardiography. Myocardial dysfunction was defined as left ventricular ejection fraction < 50 % and/or global longitudinal strain (GLS) < 16 %. Diastolic dysfunction followed standard echocardiographic guidelines. Associations between hsCRP tertiles, cardiometabolic risk factors, and cardiac structure and function were evaluated. Logistic regression assessed odds of myocardial dysfunction with hsCRP > 2 mg/L.

RESULTS: 972 adults with psoriasis were prospectively included (median age 54 years, 44.9 % women, 75.2 % moderate-to-severe psoriasis). Median hsCRP was 1.14 mg/L. Lower hsCRP levels were linked to greater biologic therapy use. Higher hsCRP was associated with older age, female sex, increased body mass index, and greater cardiometabolic risk factor burden.The highest hsCRP tertile had greater rates of myocardial dysfunction (28.8 %) and diastolic dysfunction (31.3 %) compared to the lowest tertile (17.6 % and 21.8 %, respectively, p < 0.05 for both). After multivariable adjustment, increasing hsCRP was associated with impaired GLS and LVEF, and an hsCRP > 2 mg/L was independently associated with a 45 % increased odds of myocardial dysfunction (OR 1.45, 95 % CI: 1.02 - 2.07, p = 0.042).

CONCLUSIONS: In psoriasis, elevated hsCRP was independently associated with impaired systolic function, reflected by reduced GLS and LVEF. These findings suggest systemic inflammation may be involved in early myocardial dysfunction in this population.