Background EULAR 2010 recommendations advised attention on cardiovascular (CV) risk management in patients with psoriasis arthritis (PsA) or ankylosing spondylitis (AS) because of increased CV mortality .
Objectives To investigate the distribution of CV risk factors and estimate the risk of CV death in patients with AS or PsA
Methods Outpatients with PsA or AS ≤85 years old were invited for a 30 min screening consultation with a nurse at a rheumatologic outpatient clinic. Risk factors for cardiovascular disease (total/HDL-cholesterol ratio, smoking habits, blood pressure, age and gender) were used to calculate absolute risk for CV death in 10 years according to the SCORE-system . History of CV disease (CVD) and diabetes mellitus (DM), HbA1c, Body Mass Index (BMI), alcohol consumption and exercise habits were explored. Differences between diagnoses were explored by logistic regression analysis.
Results From March 2012 through September 2013 286 patients were screened; 170 with PsA (54.7% female) and 116 with AS (29.3% female). Mean age were 54.3 (SD 12.9) and 51.6 (SD 14.0) years respectively. In total 37 (12.9%) were already diagnosed with CVD and 24 (8%) with DM. Among the 229 patients with no known DM or CVD, 26 (18.9%) PsA and 22 (23.9%) AS patients were smokers; 41 (29.9%) PsA and 21 (22.8%) AS patients had a systolic blood pressure ≥140; 89 (65.6%) PsA and 62 (67.4%) AS patients had a total cholesterol ≥5.0 mM; 20 (30.6%) PsA and 16 (33.3%) AS patients had low HDL-cholesterol (≤1.2mM for women and ≤1.0mM for men) and 2 (1.5%) with PsA and 2 (2.2%) with AS had HbA1C ≥48mM. Among the PsA patients 6 (8.9%) had an alcohol consumption above the national recommendations (max 7/14 units per week for women/men) versus 0 among AS patients (OR 1.28, p=0.012). Overall 50 (36.5%) PsA and 26 (28.3%) AS patients were obese (BMI>30) (OR 1.33; p=0.002). When adjusting for gender differences PsA patients still had an OR of 1.28, p=0.012 for obesity compared to AS patients. No significant differences between diagnoses were seen in any other risk factor. The risk SCORE (2) was ≥5 in 19 (14.1%) in PsA and 11 (12.0%) in AS patients. Patients with elevated risk for CVD were referred to follow-up by their general practitioner and community advice services. In a RA population previously screened (3) the risk SCORE was ≥5 in 12.6% and in 16.2% after adjusting the SCORE according to the EULAR recommendations (1).
Conclusions Systematic screening revealed several risk factors in patients with PsA and AS which needed medical follow-up. PsA patients had higher risk for alcohol consumptions above recommendations and obesity than patients with AS. The risk for cardiovascular death within 10 years was lower than the modified scores seen in RA patients in the same clinic (3).
Peters, MJ et al., EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis, 2010. 69(2): p. 325-31.
Conroy, RM et al., Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J, 2003. 24(11): p. 987-1003.
Primdahl J et al. Results from implementation of systematic screening for cardio vascular risk according to the EULAR recommendations in outpatients with rheumatoid arthritis. Ann Rheum Dis 2013; 72: 1771-1777.
Disclosure of Interest : None declared