Association of neutrophil-to-lymphocyte ratio with non-calcified coronary artery burden in psoriasis: Findings from an observational cohort study

Background: Inflammation in the form of elevated high-sensitivity c-reactive protein (hs-CRP) has been shown to be critical in the development of atherothrombosis. Psoriasis, a chronic inflammatory skin disease, is associated with high systemic-inflammation, elevated neutrophil-to-lymphocyte ratio (NLR) and accelerated non-calcified coronary artery burden (NCB) by coronary computed tomography angiography (CCTA). We hypothesized that NLR would associate with early, rupture-prone atherosclerosis assessed as NCB independent of hs-CRP. Methods: 316 consecutive psoriasis participants were recruited with 233 having one-year follow-up as part of a prospective, observational cohort study design. CCTA scans were performed to assess NCB in all three major epicardial coronary arteries. Results: Patients with above average NLR (>mean: 2.29 +/- 1.21) were older (mean +/- SD; 52.0 +/- 12.8 vs. 47.9 +/- 12.6, p = 0.002), had higher hs-CRP (med. IQR: 2.3 (0.9-7.3) vs. 1.4 (0.7-3.2), p = 0.001) and had higher NCB (mean +/- SD; 1.21 +/- 0.58 vs. 1.13 +/- 0.49, p = 0.018) when compared to patients with below average NLR. NLR associated with psoriasis area severity index score (13 = 0.14, p = 0.017), hs-CRP (13 = 0.16, p = 0.005), as well as NCB independent of traditional risk factors, body mass index, statin use and hs-CRP (13 = 0.08, p = 0.009). One year of biologic therapy for psoriasis was associated with a reduction in NLR (-14.5%, p < 0.001), and this change in NLR associated with change in NCB in fully adjusted models and beyond hs-CRP (13 = 0.17, p = 0.002). Conclusion: NLR associated with psoriasis severity, hs-CRP and NCB at baseline. Biologic therapy reduced NLR over time and this change in NLR associated with the change in NCB at one-year. Taken together, these findings suggest that NLR may capture psoriasis patients at higher risk of NCB due to residual inflammation not fully captured by hs-CRP.