Background SCORE understimates real Cardiovascualr Risk (CVR) in Rheumatoid ARtrhtis (1) and CVR in Psoriatic Arthritis (PsA) may be underestimated (2) too. The carotid intima-media thickness (CIMT) and the presence of atheroma plaques by Ultrasound (US) are significantly associated with risk for stroke or coronary heart disease (3) and translate a very high CVR
Objectives To assess the CVR in PsA patients according to the SCORE chart, and the presence of subclinical vascular disease by US
Methods Ongoing transversal descriptive study of PsA patients followed in our Rheumatology Division approved by the Ethic Committee of our Hospital. Clinical characteristics were recorded: age, gender, duration and type of disease, therapy; presence of classical CVR factors including body mass index (BMI), hypertension, dyslipidaemia, tobacco, and diabetes; personal and familiar cardiovascular events; lipid profile:total cholesterol (TC), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) within the previous three months. CVR was calculated with SCORE calibrated for Spain (4). The patients underwent bilateral US carotid study with a GE LOGIQ S7 US Equipment. Billaterally the CIMT and the presence of atheroma plaques were assessed according to the Mannheim consensus (5). Patientes were reclassified upon US results.
Results 40 patients included. Age was 55.8 years (SD 10.6) and 50% were female. Clinical characteristics are described in Table 1. The percentage of patients in the four levels of CVR (low, intermediate, high, and very high) was 0%, 67.5%, 25% and 7.5% respectively. 14 patients had plaques (35%), 13 (32.5%) were at the left side and 5 (12%) at the right side. In univariate analysis, plaques were associated with diabetes (P=0,005), hypertension (P=0,027) and age (P=0,039), but not with gender, dyslipidaemia, tobacco, neither length nor spectrum of the disease. 13 patients (32.5%) were reclassified and upgraded to very high risk. The final number of patients was 17 (42%), 8 (20%) and 15 (37.5%) for intermediate, high and very high risk respectively
Conclusions The preliminary results of our patients with PsA show a substantial proportion of patients with a high or very high risk a priori of a fatal CV event. SCORE classification appears to underestimate the real CV risk done as 38% of patients have an estimated very high risk after the US study. These results, even in this short series, have relevant significance as most of the patients will require a specific therapeutic approach.
Peters MJ et al. EULAR evidenced-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis2010;69:325–31.
Rosales JL et al. Cardiovascular risk assessment according to a national calibrated score risk index in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. J B Spine. 2014 Mar;:164-8.
Lin YC et al. Relationship between metabolic syndrome and carotid intima-media thickness: cross-sectional comparison between psoriasis and psoriatic arthritis. Arthritis Care Res (Hoboken). 2014 jan;66(1):97-103.
Sans S et al. Calibraciόn de la tabla SCORE del riesgo cardiovascular para España. Rev Esp Cardiol 2007;60:476–85.
T ouboul PJ et al. Mannheim carotid intima-media thickness and plaque consensus. Cerebrovasc Dis. 2012;34:290-6.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.