Background Studies have suggested that the chronic inflammatory nature of rheumatic conditions (rheumatoid arthritis (RA) and psoriatic arthritis (PsA)) as well as psoriasis (PsO) may predispose patients to cardiovascular (CV) disease and metabolic disorders. However, the individual impact of RA, PsA, and PsO on traditional CV risk factors is not well understood.
Objectives We estimated the incidence and prevalence of traditional CV risk factors - hypertension, diabetes mellitus (DM), hyperlipidemia, and obesity - among three separate cohorts of patients with RA, PsA, or PsO.
Methods Patients with RA, PsA, and PsO between January 1, 2002 and June 30, 2014 were identified (and included in three separate cohorts) in the Truven Health MarketScan Commercial and Medicare Supplemental databases. Index date was defined as the date of RA, PsA or PsO diagnosis. Patients were required to be continuously enrolled for 12 months prior to the index date. Follow-up time for the identification of the CV risk factors began on the day after index date and continued until disenrollment from MarketScan, or the end of the study. The primary outcome was the first occurrence of the CV risk factors during the follow-up period. Incidence rates (IR) per 1,000 patient-years (PY) with 95% confidence intervals (CI) were calculated. The prevalence (number of cases/total population) of CV risk factors prior to the index date was also calculated.
Results We identified 266,167 patients with RA, 35,050 with PsA, and 301,593 with PsO. Mean age at index date was similar for both PsO and PsA patients (51 yrs), but RA patients were older (58 yrs). Mean follow-up time ranged from 2.3 years to 2.5 years. Prevalence of the CV risk factors ranged as follows: hypertension 24.7% in PsO to 34.6% in RA; DM 8.2% in PsO to 10.4% in RA; Hyperlipidemia 16.5% in PsO to 18.2% in RA; and Obesity 5.1% in PsO to 6.7% in PsA. The pattern of CV risk factors development after RA, PsA, and PsO diagnosis was similar as prior to diagnosis. The RA cohort demonstrated the highest incidence of hypertension and hyperlipidemia whereas PsA cohort demonstrated the highest incidence of DM and obesity. All risk factors were lowest in the PsO cohort (Table 1).
Conclusions The incidence rates of hypertension, hyperlipidemia, DM, and obesity are higher among patients with RA and PsA compared to patients with PsO. Differences in levels of systemic inflammation may underpin differences in rates of risk factors. Different treatment strategies may be useful in preventing these comorbidities. The results highlight the importance of close monitoring and managing CV risk factors in patients with RA, PsA and PsO.
Disclosure of Interest D. Solomon Consultant for: Amgen Inc and received a research contract to assist with these analyses, T. Lesperance Employee of: Amgen Inc, H. Radner Consultant for: Amgen Inc and received a research contract to assist with these analyses, N. Accortt Employee of: Amgen Inc