Background Controversies exist regarding increased risk of cardiovascular (CV) disease in patients with psoriatic arthritis (PsA).
Objectives To compare the presence of CV risk factors and disease in patients with PsA and the normal population. Further to estimate the 10-year risk of a fatal CV event by using the Systematic Coronary Evaluation (SCORE) algorithm.1
Methods Patients and control subjects were recruited from the Nord-Trøndelag Health Study (HUNT) 3, and the diagnoses of PsA (n=338) were verified according to the Classification of Psoriatic Arthritis (CASPAR) criteria.2 The control group (n=50468) consisted of other individuals enrolled in the HUNT 3 study. Age and sex adjusted prevalence rates of CV risk factors and co morbidity were calculated.
Results Mean (SD) age was 54.3±11.9 years and 53.9±16.1 years in PsA and controls, respectively (p=0.58) and the gender ratio was nearly equally distributed in both groups (p=0.31). Patients with PsA were more often smokers compared to controls (p=0.02). The other traditional CV risk factors included in the SCORE CV risk algorithm (age, gender, systolic blood pressure and total cholesterol/HDL) were comparable between PsA patients and controls. Of untraditional CV risk factors; CRP, body mass index (BMI) and triglycerides were elevated in PsA patients compared to controls, (p<0.001, p<0.001 and p=0.01, respectively). The mean calculated CV risk (SD) in PsA patients was low (1.45±1.79) and comparable to controls (1.59±1.95) (p=0.63). The distribution across CV risk classes (low, moderate and high + very high) was comparable amongst PsA patients and controls (figure 1). There was no difference in the prevalence of established CV disease in the PsA cohort and the control group (p=0.2).
Conclusions The low CV risk in patients with PsA was related to low levels of traditional risk factors. Although, PsA patients had elevated levels of untraditional CV risk factors such as CRP, BMI and triglycerides, which are not included in the SCORE risk algorithm. Whether these factors will affect long term CV outcome is not known.
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J 2007; 28(19):2375-2414.
Hoff M, Gulati AM, Romundstad PR, Kavanaugh A, Haugeberg G. Prevalence and incidence rates of psoriatic arthritis in central Norway: data from the Nord-Trondelag Health Study (HUNT). Ann Rheum Dis 2013 Aug 20. doi: 10.1136/annrheumdis-2013-203862.
Disclosure of Interest A. Gulati: None declared, G. Haugeberg Grant/research support: Has received unrestricted grant from Pfizer., A. G. Semb: None declared, P. Romunstad: None declared, A. Kavanaugh: None declared, S. Gulati: None declared, S. C. Rollefstad: None declared, M. Hoff: None declared