Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review
- Anna Jamnitski1,
- Deborah Symmons2,
- Mike J L Peters3,
- Naveed Sattar4,
- Iain MciInnes5,
- Michael T Nurmohamed6
- 1Jan van Breemen Research Institute/READE, Amsterdam, The Netherlands
- 2ARC Epidemiology Unit, Manchester, UK
- 3Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
- 4BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- 5Department of Rheumatology, University of Glasgow, Glasgow, UK
- 6Department of Rheumatology and Internal Medicine, VUMC, Amsterdam, The Netherlands
- Correspondence to Michael T Nurmohamed, Department of Rheumatology, Jan van Breemen Research Institute/READE, Dr Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands;
- Accepted 25 March 2012
- Published Online First 24 April 2012
Objective Data regarding cardiovascular comorbidity and cardiovascular risk factors in patients with psoriatic arthritis (PsA) are limited. To evaluate the cardiovascular risk profile, a systematic literature search was performed to provide an extensive summary of all studies available on cardiovascular risk in PsA.
Methods Medline, EMBASE and the Cochrane library were searched from January 1966 to April 2011 for English language articles on data concerning cardiovascular diseases and cardiovascular risk factors in PsA. Review articles, case reports and studies on psoriasis alone were excluded.
Results Twenty-eight articles were included in this review. Studies on all-cause mortality revealed mixed results. Available data on cardiovascular disease appeared more consistent, indicating an increased cardiovascular mortality and morbidity in PsA. Commensurate with this, surrogate markers of subclinical atherosclerosis, arterial stiffness and cardiovascular risk factors, for example hypertension, dyslipidaemia, obesity and metabolic-related factors, were more prominent in PsA compared with controls. Suppression of inflammation was linked with a favourable effect on cardiovascular surrogate markers, for example carotid intima media thickness and endothelial dysfunction, in several (un)controlled studies.
Conclusion Most studies point towards an increased cardiovascular risk in PsA, broadly on a par with the risk level in rheumatoid arthritis, emphasising the need for similar cardiovascular risk management in both conditions. Further studies are needed to indicate whether inflammatory suppression or modification of traditional cardiovascular risk factors, or both, will reduce cardiovascular risk.
Funding This project was financially supported by the European League Against Rheumatism.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.