72
Context: Incidental CAC Findings and Cardiovascular Risk in Psoriatic Disease
Psoriatic disease is increasingly recognized as a systemic inflammatory condition rather than an isolated cutaneous disorder. Patients with severe psoriasis demonstrate a 1.4-fold increased risk of major adverse cardiovascular events and up to a 3-fold increased risk of myocardial infarction. Presenting at the American Society for Preventive Cardiology (ASPC) Congress on CVD Prevention, Brooke Bartley, MD, detailed findings from the STRATIFY-PsD projectโa joint initiative between dermatology and cardiology evaluating how non-gated, routine chest CT scans in electronic health records (EHRs) can identify hidden cardiovascular (CV) risk in psoriatic populations.
Key Presentation Findings & Clinical Implications
- Systemic Inflammatory Burden: Psoriasis carries a substantial cardiovascular burden. As Bartley noted, “Psoriasis is no longer considered a cutaneous disease only. It is also a systemic inflammatory problem”.
- Utility of Non-Gated Chest CTs: Qualitative coronary artery calcium (CAC) visible on routine non-gated chest CTs correlates closely with quantitative scores. Bartley stated, “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]”.
- Statin Treatment Discordance: A significant proportion of high-risk patients are not receiving guideline-directed lipid-lowering therapy. Among patients with a large amount of CAC, 21% had no documented statin use. Furthermore, 75% of patients with CAC greater than 0 and no prior atherosclerotic cardiovascular disease (ASCVD) event were not on a statin.
- Limitations of Traditional Risk Calculators: Standard predictive equations often underestimate risk in patients with systemic inflammatory diseases. In 175 patients evaluated using the PREVENT 10-year ASCVD risk score, 42.6% demonstrated moderate to large amounts of CAC, yet PREVENT categorized only 3.4% of them as high risk. Bartley emphasized, “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”.
- Interdisciplinary Care Models: To address these gaps, the researchers are implementing targeted clinical decision support alerts in the EHR. Bartley concluded, “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”.
Cohort Demographics and Coronary Artery Calcium Distribution
The table below summarizes the imaging findings from the 1,382 patients with psoriatic disease who had chest CT imaging available in the UT Southwestern EHR cohort (2020โ2025).
| Evaluated Parameter | Patient Count / Percentage | Clinical Correlates & Findings |
| Total Cohort Evaluated for CAC | 610 patients | Evaluable chest CT imaging in EHR. |
| Patients with CAC โฅ 0 | 379 patients | Positive qualitative/quantitative CAC. |
| CAC Score = 0 | 38% | No visual coronary calcification. |
| Minimal / Small CAC | 30% | Low-grade visual calcification. |
| Moderate CAC | 17% | Intermediate visual calcification. |
| Large CAC | 15% | 100% had โฅ1 ASCVD risk factor; 57.1% had prior ASCVD event. |
| Statin Gap (Large CAC) | 21% without statin | High-risk group lacking documented statin therapy. |
| Statin Gap (CAC > 0, Primary Prevention) | 75% without statin | Primary prevention cohort with zero statin documentation. |
Interactive Cardio-Dermatology Risk Estimator (CLS-Optimized Widget)
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<h4>Psoriatic Disease CV Risk Stratifier</h4>
<p>Select incidental CT findings and clinical parameters to assess statin therapy candidacy:</p>
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<label for="cacLevel">Incidental CAC on Chest CT:</label>
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<label for="priorAscvd">Prior ASCVD Event:</label>
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<option value="yes">Yes (Established ASCVD)</option>
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<h3>Cardio-Dermatology Trials & Guidelines Hub</h3>
<p>Explore active clinical trials and guidelines focused on systemic inflammation, vascular risk, and psoriatic disease:</p>
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<a href="https://pubmed.ncbi.nlm.nih.gov/" target="_blank" rel="noopener" class="cardio-trial-link">
PubMed: Psoriasis & ASCVD
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Active STRATIFY Trials
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<a href="https://www.aspconline.org/" target="_blank" rel="noopener" class="cardio-trial-link">
ASPC CVD Guidelines
</a>
<a href="https://www.aad.org/" target="_blank" rel="noopener" class="cardio-trial-link">
AAD Psoriasis Guidelines
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Video Overview: Cardiovascular Prevention in Inflammatory Skin Disease
Below is an embedded visual presentation summarizing the intersection of inflammatory skin disorders and cardioprevention.
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Reference
- Bartley B, et al. Spotlight session โ STRATIFY-PsD: Incidental coronary artery calcium findings in psoriatic disease. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 31-Aug 2, 2026; Scottsdale, Arizona.
