Elnabawi YA, Oikonomou EK, Dey AK, et al. - Using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition through coronary computed tomography angiography (CCTA), researchers explored the relationship of biologic therapy with coronary inflammation in psoriasis patients. Participants in the study were 134 consecutive patients with moderate to severe psoriasis. Most patients had a low cardiovascular risk, which was determined by traditional risk scores, and moderate to severe skin disease. A total of 82 and 52 patients underwent biologic psoriasis therapy for 1 year and did not receive any biologic therapy and were given topical or light therapy, respectively. Forty-six patients at baseline had focal coronary atherosclerotic plaque. Biologic therapy was correlated with a significant decline in FAI at 1 year concurrent with skin disease improvement. On the other hand, no change in FAI was observed in those who did not get biologic therapy. The correlations with FAI were independent of the presence of coronary plaque and were consistent among individuals who took various biologic agents, including anti-tumor necrosis factor α and anti–interleukin (IL)-12/23 or anti–IL-17 therapy. Overall, biologic therapy for moderate to severe psoriasis was linked to decreased coronary inflammation evaluated by perivascular FAI. In addition, for coronary artery disease, perivascular FAI calculated by CCTA can be utilized to track response to interventions.