Cardiovascular Risk in Pediatric Psoriasis

Psoriasis is a common inflammatory skin disorder associated with an increased risk of cardiovascular disease (CVD) in affected adults, even when adjusted CVD risk factors, such as obesity, hyperlipidemia, hypertension, and diabetes, other disorders linked to psoriasis. Studies with systemic medications, particularly biologics, have suggested that intervention for the psoriasis concurrently reduces the risk of development and progression of the CVD. One-third of patients with psoriasis noted the onset during pediatric years, raising the possibility that early intervention to suppress systemic immune activation leading to CVD could alter long-term outcome. However, there are no current biomarkers of early CVD in children and adolescents. Gray-level difference statistic-contrast ultrasound is a new technology that, when coupled with measurements of carotid intima-media thickness and flow mediated dilation studies, allows sensitive, noninvasive detection of early CVD, including in children. We will test whether this technology is able to detect early evidence of atherosclerosis in children with moderate-to-severe psoriasis when compared with readings in age- and body mass index-matched healthy children. We will couple the imaging analysis with clinical data and proteometric assays of tape stripped skin and, if possible, serum to quantify inflammatory and cardiovascular risk biomarkers. If we can detect early evidence of CVD in pediatric patients with psoriasis using these noninvasive tools, we will have the preliminary data to initiate a large, long-term multi-center study that evaluates the impact of systemic therapy on CVD risk in children with psoriasis.