Elsevier

Joint Bone Spine

Volume 81, Issue 2, March 2014, Pages 164-168
Joint Bone Spine

Original article
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

https://doi.org/10.1016/j.jbspin.2013.07.008Get rights and content

Abstract

Objective

To assess cardiovascular (CV) risk in psoriatic arthritis (PsA) patients without clinically evident CV disease or classic atherosclerosis risk factors according to the SCORE chart following the EULAR recommendations.

Methods

Eighty PsA patients without previous CV events or atherosclerosis risk factors and eighty matched controls were included. Information on demographic, anthropometric and clinical-serological data of disease was assessed. The national calibrated Systematic Coronary Risk Evaluation (SCORE) index was calculated and the association between this SCORE and clinical-serological data of these patients was analyzed.

Results

PsA patients had higher acute phase reactants as well as higher SCORE mean values than healthy controls (1.99 ± 3.52 vs. 1.0 ± 1.74; P = 0.028). According to SCORE definitions, 71 (89%) patients had low-intermediate CV risk and 9 (11%) were above the threshold of high risk. In the control group, 76 (95%) had low-intermediate risk and four (5%) had high CV risk. However, there were no differences in CV risk stratification between both groups (P = 0.148). PsA patients with high-very high CV risk had longer disease duration (P = 0.001) and higher levels of triglycerides (P = 0.009). PsA patients showed a significant correlation between SCORE values and disease duration (β = 0.185; P = 0.0001) and the average annual levels of C reactive protein (CRPa), β = 2.38; P = 0.014.

Conclusion

CV risk assessment in PsA patients without clinically evident CV disease or classic atherosclerosis risk factors may be underestimated by using only the SCORE chart. In these patients, disease duration and the CRPa may help to establish a better stratification of the actual CV risk.

Introduction

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by synovial, entheseal inflammation and psoriasis [1]. Most studies indicate an increased cardiovascular (CV) morbidity and mortality in PsA patients [2], [3], [4]. In this regard, the risk of having myocardial infarction, ischemic heart disease, hypertension, diabetes and dyslipidemia were found to be increased in cross-sectional and longitudinal prospective cohorts [5], [6].

The systematic coronary risk evaluation (SCORE) project was initiated to develop a risk scoring system for use in the clinical management of CV risk in European clinical practice [7]. The SCORE risk estimation system offers direct estimation of total fatal CV risk in a format suited to the constraints of clinical practice [7]. The Fourth Joint Task Force on CV disease prevention in clinical practice recommended the use of the SCORE charts to assess CV risk in general population [8] and the recent task force of the European League against Rheumatism (EULAR) recommended the use of local guidelines for CV risk assessment and treatment in patients with chronic inflammatory rheumatic diseases [9]. In our country, a calibrated national SCORE chart was published by the Spanish Society of Cardiology [10].

Taken together all these considerations, in the present study we aimed to assess the CV risk in a series of Southern Spanish PsA patients without history of classic CV risk factors and CV events, according to a national calibrated SCORE following the EULAR recommendations. We also analyzed the correlation between this SCORE and clinical and serological data of the PsA patients.

Section snippets

Patients

Eighty consecutive patients diagnosed with PsA according to the Moll and Wright criteria (presence of inflammatory arthritis, presence of psoriasis and absence of serologic test for rheumatoid factor). For this purpose, in an attempt to minimize the potential confounding effect mediated by the presence of classic CV risk factors, patients with PsA assessed during the period of recruitment with classic CV risk factors and or history of CV events were excluded. Patients were recruited from the

Results

Demographic and disease characteristics, clinical and serological disease activity parameters and lipid profile of the patients included in the study are shown in Table 1. No significant differences between patients and controls in the age, gender and BMI was found. PsA patients had higher acute phase reactants than healthy controls. Nevertheless, there were no differences in the lipid profile in both groups, except for LDL-C levels that were higher in the control group.

PsA patients had higher

Discussion

Current mortality studies in PsA patients suggest an increased mortality rate, being CV diseases (myocardial infarction, cerebrovascular accidents and congestive heart failure) the leading causes responsible for 20 to 56% of all causes of death [11], [12]. Likewise, PsA patients have an increased prevalence of hypertension, obesity, hyperlipidemia and type 2 diabetes mellitus compared with those with psoriasis alone [13]. It is also well known that PsA patients frequently develop premature

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Author's contributions: J.R., J.S., J.C., C.M., M.G. and E.R. participated in the design of the study. J.R., C.M. and J.S. participated in the recruitment of patients. J.R., J.C., J.S. and M.G. conducted data analysis and interpretation. J.R., J.S., J.C., C.M., M.G. and E.R. participated in the manuscript preparation. All authors have read and approved the final manuscript.

Acknowledgements

We would like to thank research nurses Mrs. M. Sola, Mrs. T. Alonso, Mrs. M. Álvarez and Miss C. Linares for performing laboratory assessments.

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