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Dr Thomas Nero discusses inflammation and the role of rheumatologic disorders on coronary artery disease with Dr Nehal Mehta, exploring how chronic inflammation serves as a cornerstone for various health issues, particularly in patients with conditions like psoriasis and serves as a model for investigating cardiovascular therapies. The discussion highlights the role of immune responses, the impact of lifestyle factors, and the importance of early diagnosis and risk assessment in managing cardiovascular health.

Early Research

• Dr Mehta's research began by observing obese patients with heart attacks despite few cardiovascular risk factors.
• He found adipose inflammation was driving obesity and insulin resistance.
• Psoriasis became a model for studying chronic inflammation's effects on cardiovascular health.

Inflammation and Cardiovascular Disease

• Atherosclerosis requires both injury and lipids.
• Endothelial damage initiates inflammation in atherosclerosis.
• Neutrophils and myeloid cells play a critical role in the inflammatory process.
• Different inflammatory diseases have distinct cytokine profiles (e.g., psoriasis vs. lupus).

Adipose Tissue and Inflammation

• Visceral fat is metabolically active and a key site of inflammation.
• Psoriatic flares increase visceral fat volume and adipose tissue macrophages.
• Obese psoriasis patients have higher risks of cardiovascular events.

Coronary Artery Disease in Inflammatory Conditions

• Coronary inflammation can be detected by perivascular fat attenuation index (pFAI).
• Untreated psoriasis patients show progression from inflammation to plaque formation.
• Coronary artery calcium (CAC) scoring may underestimate disease in younger patients.

Diagnostic Approaches

• Dr. Mehta recommends assessing blood pressure, body mass index, lipids, and glucose.
• Neutrophil-lymphocyte ratio (NLR) and GlycA are useful inflammatory markers.
• Imaging like carotid intima-media thickness and pFAI can help identify early vascular disease.

Treatment Strategies

• Early statin initiation is recommended for psoriasis patients.
• Ongoing trials are exploring various anti-inflammatory agents (e.g., colchicine, IL-6 inhibitors).
• Future therapies may include oral IL-23 inhibitors and weight loss medications.

Future Research Directions

• Retinal arteries as a model for studying vascular disease and lipid deposition.
• Exploring lipid accumulation in various tissues, including the central nervous system.
• Developing therapies to address lipid-driven processes in diseases of aging.

The discussion emphasizes the complex interplay between inflammation, lipid metabolism, and cardiovascular disease, highlighting the need for personalized approaches and continued research in this field.