Key takeaways:

• Incidental coronary artery calcium findings can help identify which patients with psoriatic disease need CV risk management.
• Some high-risk patients with psoriatic disease were not on statin therapy.

SCOTTSDALE, Ariz. — Incidental qualitative coronary artery calcium findings can identify which patients with psoriatic disease need their cardiovascular risk managed, researchers reported.

In a presentation that won the award for best oral abstract on the second day of the American Society for Preventive Cardiology Congress on CVD Prevention, Brooke Bartley, MD, dermatology resident at University of Texas Medical Branch and UT Southwestern Medical Center, discussed findings from the STRATIFY-PsD project.

Incidental coronary artery calcium findings can help identify which patients with psoriatic disease need CV risk management. Image: Adobe Stock

“This is a joint initiative between cardiology and dermatology, and it explores the intersection of cardioprevention and inflammatory skin diseases, specifically psoriasis,” Bartley said during the presentation. “Psoriasis is no longer considered a cutaneous disease only. It is also a systemic inflammatory problem. In fact, our patients with severe psoriasis have a 1.4 times risk of major cardiovascular events and up to a three times risk of MI. In a study done by one of our coinvestigators on this initiative, they found that CAC is often incidentally visible on regular CT chest scans that are already in our patients’ charts, not just gated CT scans. And they found that visual estimates broadly tracked with real scores, especially in the moderate to severe calcium readings. That means we could possibly correlate our quantitative and qualitative values to find our highest-risk patients using what already is in the [electronic health record].”

Of the 4,291 patients with psoriatic disease treated at UT Southwestern between 2020 and 2025, 1,382 had chest CT imaging available in the EHR, 610 of those were evaluable for CAC, and of those, 379 had CAC of at least 0, Bartley said.

Among those with a CAC measurement, 38% had a CAC of 0, 30% had a minimal or small amount of CAC, 17% had a moderate amount and 15% had a large amount, she said.

Among those with a large amount of CAC, all had at least one risk factor for atherosclerotic CVD and 57.1% had a prior ASCVD event, Bartley said.

The data revealed that there was discordance between statin use and CV risk, with 21% of those with a large amount of CAC having no record of statin use and 75% of those with CAC of at least 0 but no prior ASCVD having no documented statin use, she said.

The researchers also calculated the PREVENT 10-year ASCVD risk score for 175 patients from the cohort without prior ASCVD. Among those patients, 42.6% had moderate or large amounts of CAC, but of them, only 3.4% were classified by PREVENT as having high 10-year ASCVD risk, she said.

In addition, more than half of patients with moderate or large amounts of CAC were not on a statin, Bartley said.

“Our scores and our equations may not be fully capturing the CV risk factors that we see in our psoriatic disease patients. CAC can add this additional helpful information in order to identify our highest-risk groups,” Bartley said during the presentation. “We didn’t want to just identify the gap; we wanted to be part of the solution. And we are creating, developing and implementing our own practices alert to bridge the gap in psoriatic disease and cardiovascular disease patient care. Innovative solutions like the cardio-dermatology program and cardiology and dermatology collaboration are needed to optimize the treatments for our psoriatic disease [and] inflammatory skin disease patients.”