Background A higher prevalence of cardiovascular (CV) risk factors has been described in patients (pts) with psoriatic arthritis (PsA) and with moderate to severe chronic plaque psoriasis (PS). Stratifying cardiovascular risk using calibrated risk charts is central to decision-making on treatment to prevent CV disease
Objectives To assess and compare the CV risk in pts with PsA, pts with PS alone and controls without clinically evident CV disease using a calibrated SCORE. Compare these results with the presence of subclinical atherosclerosis assessed by carotid ultrasound (CCA US)
Methods We included 80 consecutive PsA patients who fulfilled the CASPAR criteria, 80 patients with PS and 80 age and sex matched controls. Patients with a previous CV event and diabetics were excluded. CV risk was calculated using the cSCORE (high CV risk has been defined by a SCORE ≥ 5%), and the presence of plaques was evaluated by B-doppler US. A one-way ANOVA was performed to analyze the statistical difference between groups and the concordance (Kappa Index) was calculated. Furthermore, multivariate regression analysis was used to adjust for gender, age, body mass index, classic CV risk factors, clinical and laboratory patterns, treatment, activity of disease, and inflammatory markers (p<0,05 was considered significant)
Results Based on the classic CV risk factors, the cSCORE in the PsA patients was 1,70 ± 3,22% (mean ± standard deviation) and 7 pts (8,75%) were above the threshold of high or very high CV risk (≥5%). In the groups of PS and controls after applying the cSCORE the values were 1,45 ± 2,41 and 1,17 ± 1,75. Therefore, 5 pts (6,25%) were classified above the threshold in both groups. The CCA US revealed the presence of atherosclerotic plaques in 8 pts (10%) with PsA, 9 pts (11,25%) with PS and 2 (2,5%) in the group of healthy controls. Statistical difference intergroups was not significant for the cSCORE or the presence of plaques. Furthermore the cSCORE showed a bad concordance (Kappa Index 0,51, 0,34 and 0,2, in the PsA, PS and controls group respectively) with the presence of plaques. Multivariate regression analysis showed that the only prognostic factors for predicting the cSCORE in the three groups was the age (p< 0,05) and the variables associated with subclinical atherosclerosis in the PsA pts were the age and the CRP (p< 0,05), in PS, the age, gender and total cholesterol level (< 0,05) and in the group of healthy controls the age. Clinical patterns of the PsA and PS, treatment and activity of the disease were not associated with cSCORE.
Conclusions In our study most of the patients with PsA and PS have low and intermediate CV risk using the cSCORE. The correlation between cSCORE and CCA US was poor. cSCORE may understimate the CV risk assessment in patients with PsA and PS. Besides classic CV risk factors, some disease characteristics might contribute to the expression of higher global CV risk in these patients.
References Gonzalez-Juanatey C et al. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007;57:1074-80.
Disclosure of Interest None Declared
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