Ann Rheum Dis doi:10.1136/ard.2008.094839

Cardiovascular morbidity in psoriatic arthritis (PsA)

  1. Dafna D Gladman (dafna.gladman{at}
  1. Centre for Prognosis Studies, Canada
    1. Miriam Ang (m.ang{at}
    1. Univesrity of Toronto, Canada
      1. Li Su ({at}
      1. MRC Biostatistics Unit, Institute of Public Health, United Kingdom
        1. Brian DM Tom (brian.tom{at}
        1. MRC Biostatistics Unit, Institute of Public Health, United Kingdom
          1. Catherine T Schentag, PhD (cathy.schentag{at}
          1. Toronto Western Hospital, Canada
            1. Vernon T Farewell (vern.farewell{at}
            1. MRC Biostatistics Unit, Institute of Public Health, United Kingdom
              • Published Online First 12 August 2008


              Background: Increasing evidence for cardiovascular mortality among patients with psoriasis and psoriatic arthritis (PsA) has accumulated, together with evidence for increased frequency of risk factors for cardiovascular disease.

              Objectives: To describe cardiovascular morbidity in PsA, determine its prevalence, and identify risk factors for its development.

              Methods: At the University of Toronto, patients have been followed prospectively according to a standard protocol including disease related features as well as co-morbidities. Patients with cardiovascular disease (CVD) including myocardial infarction (MI), angina, hypertension (HTN), and cerebrovascular accident (CVA) were identified. The prevalences of CVD morbidities in these patients were compared to data from the Canadian Community Health Survey (CCHS) through Standardized Prevalence Ratios (SPRs). Risk factor analyses are undertaken through use of Cox relative risk regression analysis.

              Results: At the time of analysis, 648 patients were registered in the database. After clinic entry, 122 developed hypertension, 38 had an MI, and 5, 21 and 11 had CVA, angina and congestive heart failure (CHF) respectively. A total of 155 patients had at least one of these conditions observed. The SPRs for MI [2.57; 95% CI: (1.73, 3.80)], angina [1.97; : (1.24, 3.12)] and hypertension [1.90; (1.59, 2.27)], were statistically significant, whereas the SPRs for CHF [1.19; : (0.50, 2.86)] and CVA [0.91;: (0.34, 2.43)] were not. Factors associated with CVD included diabetes, hyperlipidemia and high PASI scores.

              Conclusion: Patients with PsA are at increased risk of cardiovascular morbidities compared to the general population. In addition to known risk factor for CVD, severe psoriasis is an important predictor in patients with PsA.

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