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DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study
  1. Steven Ho Man Lam1,
  2. Isaac T Cheng2,
  3. Edmund K Li2,
  4. Priscilla Wong3,
  5. Jolie Lee4,
  6. Ronald Man-Lung Yip5,
  7. Cheuk-Wan Yim6,
  8. Shirley K Ying7,
  9. Martin Li2,
  10. Tena K Li2,
  11. Alex Pui-Wai Lee2,
  12. Lai-Shan Tam1
  1. 1 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong
  2. 2 Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  3. 3 Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  4. 4 Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, Hong Kong
  5. 5 Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
  6. 6 Department of Medicine, Tseung Kwan O Hospital, Hong Kong, Hong Kong
  7. 7 Department of Medicine, Princess Margaret Hospital, Hong Kong, China
  1. Correspondence to Steven Ho Man Lam, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, New Territories, Hong Kong; hmlam{at}link.cuhk.edu.hk

Abstract

Objective To examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis.

Methods A cohort analysis was performed in patients with PsA who had been followed since 2006. The outcome of interest was first CV event. Four different CV disease (CVD) risk scores and DAPSA were computed at baseline. The presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) was also determined in a subgroup of patients using high-resolution ultrasound. The association between DAPSA, CVD risk scores, CP, CIMT and the occurrence of CV events was assessed using Cox proportional hazard models.

Results 189 patients with PsA (mean age: 48.9 years; male: 104 (55.0%)) were recruited. After a median follow-up of 9.9 years, 27 (14.3%) patients developed a CV event. Higher DAPSA was significantly associated with an increased risk of developing CV events (HR: 1.04, 95% CI (1.01 to 1.08), p=0.009). The association remained significant after adjusting for all CV risk scores in the multivariable models. In the subgroup analysis, 154 patients underwent carotid ultrasound assessment and 23 (14.9%) of them experienced a CV event. CP was associated with increased risk of developing CV events after adjusting for three CV risk scores and DAPSA, with HR ranging from 2.35 to 3.42.

Conclusion Higher DAPSA and the presence of CP could independently predict CVD events in addition to traditional CV risk scores in patients with PsA.

  • arthritis, psoriatic
  • cardiovascular diseases
  • ultrasonography
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Footnotes

  • Handling editor Josef S Smolen

  • Contributors All authors critically revised the manuscript for important intellectual content. Specific roles included study design (L-ST, SHML), data collection (L-ST, EKL, PW, JL, RM-LY, C-WY, SKY, ML, TKL, ITC, SHML, AP-WL), data analysis (SHML) and drafting of the manuscript (SHML, L-ST).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by The Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (no. 2012.478).

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

  • Data availability statement No data are available.

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