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Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease
  1. Jiayun Shen1,
  2. Ka-Tak Wong2,
  3. Isaac T Cheng1,
  4. Qing Shang1,
  5. Edmund K Li1,
  6. Priscilla Wong1,
  7. Emily W Kun3,
  8. Mei Yan Law3,
  9. Ronald Yip4,
  10. Isaac Yim5,
  11. Shirley Ying6,
  12. Martin Li1,
  13. Tena K Li1,
  14. Chun-Kwok Wong7,
  15. Tracy Y Zhu8,
  16. Jack Jock-Wai Lee9,
  17. Mimi Chang1,
  18. Alex Pui-Wai Lee1,
  19. Lai-Shan Tam1
  1. 1Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  2. 2Department of Diagnostic and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  3. 3Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
  4. 4Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
  5. 5Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
  6. 6Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong
  7. 7Department of Chemical Pathology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  8. 8Bone Quality and Health Center of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  9. 9Division of Biostatistics, The Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Dr Lai-Shan Tam, Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong; lstam{at}cuhk.edu.hk

Abstract

Objectives To evaluate coronary atherosclerosis in patients with psoriatic arthritis (PsA) and control subjects using coronary CT angiography (CCTA).

Methods Ninety consecutive patients with PsA (male: 56(62.2%); 50.3±11.1 years) were recruited. 240 controls (male: 137(57.1%); 49.6±10.7 years) without known cardiovascular (CV) diseases who underwent CCTA due to chest pain and/or multiple CV risk factors were recruited for comparison.

Results Patients with PsA and controls were matched in age, gender and traditional CV risk factors (all p>0.2). The prevalence of overall plaque (54(60%)/84(35%), p<0.001), calcified plaque (CP) (29(32%)/40(17%), p=0.002), mixed plaque (MP) (20(22%)/18(8%), p<0.001), non-calcified plaque (NCP) (39(43%)/53(22%), p<0.001) and combined MP/NCP (46(51%)/62(26%), p<0.001) were all significantly higher in patients with PsA. Three-vessel disease was diagnosed in 12(13%) patients with PsA and 7(3%) controls (p<0.001), while obstructive plaques (>50% stenosis) were observed in 8(9%) patients with PsA and 7(3%) controls (p=0.033). After adjusting for traditional CV risk factors, PsA remained an independent explanatory variable for all types of coronary plaques (OR: 2.730 to 4.064, all p<0.001). PsA was also an independent explanatory variable for three-vessel disease (OR: 10.798, p<0.001) and obstructive plaque (3.939, p=0.024). In patients with PsA, disease duration was the only disease-specific characteristic associated with more vulnerable plaques (MP/NCP) in multivariate analysis (1.063, p=0.031). The other independent explanatory variables were age ≥55 years (5.636, p=0.005) and male gender (8.197, p=0.001).

Conclusions Patients with PsA have increased prevalence, burden and severity of coronary atherosclerosis as documented by CCTA. Longer disease duration was independently associated with the presence of vulnerable MP/NCP plaques in patients with PsA.

Trial registration number NCT02232321.

  • Psoriatic Arthritis
  • Cardiovascular Disease
  • Atherosclerosis

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors L-ST had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. LST, KTW and JS: study design. L-ST, K-TW, ITC, QS, EKL, PW, EWK, MYL, YR, IY, SY, ML, TKL, C-KW, TYZ, MC and AP-WL: acquisition of data. L-ST, JS, ITC and JJ-WL: analysis and interpretation of data. JS and L-ST: manuscript preparation.

  • Funding Health and Medical Research Fund (01120496).

  • Competing interests None declared.

  • Ethics approval Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (the Joint CUHK-NTEC CREC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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