Background Cardiovascular(CV) comorbidities are an important issue of inflammatory arthritis (1.2), given that mortality increases with the severity form of the disease(3). CV risk factors and metabolic factors were present more frequent in patients with psoriatic arthritis(PA) than in controls (1,2,4). Psoriasis is considered by some authors as an independent risk factor for CV disease (5). So, like the newest published study, further study are needed to indicate whether inflammatory suppresion or modification of traditional CV risk factors will reduce CV risk (1).
Objectives To assess presence of CV comorbidities and relation with CV risk factors in patients with PA
Methods 88 patients diagnosed with AP CASPAR criteria were examined by medical history (demographic data), clinical (anthropometrical data, assessment of skin activity by PASI score), biological (blood glucose, lipid profile) and imaging (EEG, abdominal ultrasonography, cardio-thoracic radiography). The CV comorbidities were established by a cardiologist. The severe skin disease was considered with a PASI score over 10.
Results 72.8% of patients were caucasians, 59.1% women, with a median age of 55.63 ± 11.16 (31-80) years. We analyzed the cohort starting from each known CV risk factors (age over 50 years, smoking status, obesity, dislipidemia) and extended skin damage. Age over 50 years and dislipidemia were associated with CV (ischemic heart disease 20-30%, p= 0.032; hypertension 54-56.7%, p=0.008) and metabolic disease (diabetes 31.7%, p=0.005; hepatic steatosis 28.3%, p=0.028). Only 28.6% of smokers have hypertension (p=0.038). Obese patients with AP shows CV disease, hypertension was present in 61.5% (p=0.07), and ischemic heart diseaseonly in 25.6% (p=0.067).38.5% of obese are diabetic patients (p=0.003) and 40% shows hepatic steatosis (p=0.01). Regarding patients with extensive skin involvement notice that 90% of these shows dyslipidemia (p = 0.012) and 80% hypertension (p = 0.027). The risk of developing hypertension given age was 50 years (RR=3.27), presence of diabetes (RR = 2.03), obesity (RR = 2.09), but especially severe skin damage (RR=6.65). The risk of developing ischemic heart disease was conferred by a family history of psoriasis (RR=2.32), presence of dyslipidemia (RR=1.31), presence of diabetes (RR=6.4), presence of obesity (RR=2.2) and in a small extent the score PASI(RR=1.31).
Conclusions Besides the recognized CV risk factors(age, obesity, smoke, dislipidemia), psoriasis is an additional and significant risk factor for CV comorbidities in patients with psoriatic arthropathy.
Jamnitski A et al, CV comorbidities in patients with psoriatic arthritis, AnnRheumDis, 2013, 72: 211-6
Soltani-ArabshahiR et al, Obesity in early adulthood as a risk factor for psoriatic arthritis, Arch Dermatol. 2010 Jul;146(7):721-6.
Arumugam R, McHugh NJ, Mortality and causes of death in psoriatic arthritis, J Rheumatol Suppl 2012, 89: 32-5
Love TJ et al, Obesity and the risk of psoriatic arthritis: a population-based study, Ann Rheum Dis. 2012 Jun 26.
Ahlehoff O et al, Psoriasis is associated with clinically significant cardiovascular risk, J Intern Med 2011, 2011: 270: 147-57
Disclosure of Interest None Declared
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