Chronic Stress-Related Neural Activity Associates With Subclinical Cardiovascular Disease in Psoriasis: A Prospective Cohort Study

JACC Cardiovasc Imaging. 2020 Feb;13(2 Pt 1):465-477. doi: 10.1016/j.jcmg.2018.08.038. Epub 2018 Nov 15.


Objectives: This study hypothesized that there is an association between chronic stress (as indexed by resting amygdalar activity [AmygA]), hematopoietic system activity (HMPA), and subclinical cardiovascular indexes (aortic vascular inflammation [VI] and noncalcified coronary plaque burden [NCB]) in psoriasis (PSO). The study also hypothesized that treatment of PSO would improve these parameters.

Background: PSO is a stress-related chronic inflammatory condition that is associated with increased prevalence of subclinical cardiovascular disease (CVD). In individuals without PSO, stress has been linked to CVD through a serial biological pathway that involves the amygdala, hematopoietic tissues, and atherosclerotic plaques.

Methods: A total of 164 consecutive patients with PSO and 47 healthy volunteers underwent 18-fluorodeoxyglucose positron emission tomography/computed tomography scans for assessment of AmygA, HMPA, and VI, as well as coronary computed tomography angiography scans for quantifying NCB. Furthermore, a consecutive subset of 30 patients with severe PSO (Psoriasis Area Severity Index Score >10) were followed at 1 year to assess the relationship between skin disease improvement and AmygA, HMPA, VI, and NCB.

Results: The PSO cohort was middle-aged (mean age: 50 years), had low cardiovascular risk (Framingham risk score: median: 3) and had mild to moderate PSO activity (median Psoriasis Area Severity Index Score: 5.6). AmygA was higher in patients with PSO compared to volunteer participants. AmygA was associated with HMPA (bone marrow activity: β = 0.20, p = 0.01) and subclinical CVD (VI: β = 0.31, p < 0.001; NCB: β = 0.27, p < 0.001) The AmygA-CVD association was in part mediated by HMPA (VI: 20.9%, NCB: 36.7%). Following 1 year of PSO treatment in those with severe disease, improvement in skin disease was accompanied by a reduction in AmygA, bone marrow activity, and VI, with no progression of NCB.

Conclusions: In PSO, a chronic inflammatory disease state, AmygA, which is a manifestation of chronic stress, substantially contributes to the risk of subclinical CVD. Additional studies that use psychometric measures of stress are required to explore therapeutic impact.

Keywords: amygdala; atherosclerosis; inflammation; psoriasis; stress.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Amygdala / diagnostic imaging
  • Amygdala / physiopathology*
  • Anti-Inflammatory Agents / therapeutic use
  • Asymptomatic Diseases
  • Cardiovascular Diseases / diagnostic imaging
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Case-Control Studies
  • Chronic Disease
  • Computed Tomography Angiography
  • Coronary Angiography
  • Cross-Sectional Studies
  • Female
  • Fluorodeoxyglucose F18 / administration & dosage
  • Hematopoietic System / diagnostic imaging
  • Hematopoietic System / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Predictive Value of Tests
  • Prospective Studies
  • Psoriasis / complications*
  • Psoriasis / diagnostic imaging
  • Psoriasis / drug therapy
  • Psoriasis / physiopathology
  • Radiopharmaceuticals / administration & dosage
  • Risk Factors
  • Single Photon Emission Computed Tomography Computed Tomography
  • Stress, Psychological / diagnostic imaging
  • Stress, Psychological / etiology*
  • Stress, Psychological / physiopathology
  • Treatment Outcome
  • United States / epidemiology


  • Anti-Inflammatory Agents
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18