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Cardiovascular morbidity in psoriatic arthritis
  1. D D Gladman1,
  2. M Ang1,
  3. L Su2,
  4. B D M Tom2,
  5. C T Schentag1,
  6. V T Farewell2
  1. 1
    Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
  2. 2
    MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
  1. Dr D D Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst St Toronto, Ontario M5T 2S8, Canada; dafna.gladman{at}


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

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

Methods: At the University of Toronto, patients were followed up prospectively according to a standard protocol, including disease-related features and comorbidities. Patients with CVD, including myocardial infarction (MI), angina, hypertension and cerebrovascular accident (CVA), were identified. The prevalence of CVD morbidities in these patients was compared with data from the Canadian Community Health Survey through standardised prevalence ratios (SPRs). Cox relative risk regression analysis was used to analyse risk factors.

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. 155 patients had at least one of these conditions. The SPRs for MI (2.57; 95% CI 1.73 to 3.80), angina (1.97; 95% CI 1.24 to 3.12) and hypertension (1.90; 95% CI 1.59 to 2.27) were statistically significant, whereas the SPRs for CHF (1.19; 95% CI 0.50 to 2.86) and CVA (0.91; 95% CI 0.34 to 2.43) were not. Factors associated with CVD included diabetes, hyperlipidaemia and high Psoriasis Area and Severity Index scores.

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

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  • Funding: LS, BDMT and VTF were supported by Medical Research Council, UK, funding (U.1052.00.009). MA was supported by grants from the Institute of Medical Science, University of Toronto and the Babylon Foundation. This study was supported by the Canadian Institute of Health Research, The Krembil Foundation and the Institute of Medical Science.

  • Competing interests: None.

  • Ethics approval: Obtained.

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