Premature Coronary Artery Disease (CAD) in Severe Psoriasis

Inclusion Criteria: 1. Patients with severe psoriasis as determined by more than two episodes of systemic or inpatient treatment and 10% or more body surface area involvement. 2. Male or female ages 18 to 55 (because CAD risk has been shown to be greatest in younger psoriasis patients in earlier studies, this pilot study will focus on young individuals). 3. Able to give informed consent Exclusion Criteria: 1. Prior diagnosis of CAD (coronary artery disease) or heart disease based upon one or more of the following: * coronary arteriography * percutaneous coronary intervention * cardiac surgery including bypass graft surgery * valve surgery * congenital heart disease repair * stress ECG or imaging * myocardial infarction * angina or unstable angina * congestive heart failure * cardiomyopathy 2. History of anti-oxidants such as fish oil or biologic therapy Tumor Necrosis Factor alpha inhibitors (such as etanercept, adalimumab, or infliximab). A recent review by Sattar et al \[22\] has shown preliminary evidence that TNF (tumor necrosis factor) blockade can modulate nontraditional cardiovascular risk factors such as C-reactive protein(CRP), Interleukin-6(IL-6), Apolipoprotein AI(ApoAI), Lipoprotein(a)(Lp\[a\]), Sex Hormone Binding Globulin (SHBG), and homocysteine to exert a possible vascular and metabolic protective effect. 3. Pustular and erythrogenic psoriasis 4. Unable to give informed consent 5. Contraindications to coronary CT, including: * Irregular heart rate, such as multiple PVCs (premature ventricular contractions), atrial fibrillation * Active heart failure * Serum creatinine \> 1.5mg/dl * Weight \> 320 lbs (due to degradation in CT (computerized tomography)image quality by image noise) * History of severe allergy to intravenous contrast media * High irregular heart rate with contraindications to beta-blockers * Pregnant