Cholesterol efflux capacity is associated with lipoprotein size and vascular health in mild to moderate psoriasis.

Background And Objective: Psoriasis is a systemic inflammatory condition with poor cholesterol transport measured by cholesterol efflux capacity (CEC) that is associated with a heightened risk of cardiovascular disease (CVD). In psoriasis patients, we sought to characterize the lipoprotein profile by size using a novel nuclear magnetic resonance algorithm in patients with low CEC compared to normal CEC.

Methods: Lipoprotein profile was assessed using the novel nuclear magnetic resonance LipoProfile-4 deconvolution algorithm. Aortic vascular inflammation (VI) and non-calcified burden (NCB) were characterized positron emission tomography-computed tomography and coronary computed tomography angiography. To understand the relationship between lipoprotein size and markers of subclinical atherosclerosis, linear regression models controlling for confounders were constructed.

Results: Psoriasis patients with low CEC had higher more severe psoriasis ( = 0.04), VI ( = 0.04) and NCB ( = 0.001), concomitant with smaller high-density lipoprotein (HDL) ( < 0.001) and low-density lipoprotein (LDL) particles ( < 0.001). In adjusted models HDL size ( = -0.19; = 0.02) and LDL size ( = -0.31; < 0.001) associated with VI and NCB. Lastly, HDL size strongly associated with LDL size in fully adjusted models ( = -0.27; < 0.001).

Conclusion: These findings demonstrate that in psoriasis, low CEC associates with a lipoprotein profile comprised of smaller HDL and LDL particles which correlates with vascular health and may be driving early onset atherogenesis. Further, these results demonstrate a relationship between HDL and LDL size and provide novel insights into the complexities of HDL and LDL as biomarkers of vascular health.