Identifying Patients With Psoriatic Arthritis Who Need Cardiovascular Risk Factor Interventions

Patients with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD), but just using the Framingham risk score (FRS) to differentiate patients with PsA with and without coronary artery disease (CAD) is suboptimal and can underestimate cardiovascular (CV) risks in these patients.

Using FRS along with carotid intima-media thickness (cIMT) and the presence of plaque and total plaque area (TPA) may help to improve CV risk stratification for patients with PsA, according to a study published in RMD Open.

The study included 91 patients with PsA without overt CVD. Coronary CT angiography scans, a noninvasive and accurate method to assess coronary atherosclerosis, were performed. CV risk was assessed using FRS, and disease activity was assessed using Disease Activity in Psoriatic Arthritis.

The FRS identified 53 patients (58.2%) as having low CV risk, 25 (27.5%) as having intermediate risk, and 13 (14.3%) as having high risk. Carotid plaques were identified in 35 patients, and coronary plaques were identified in 54 patients. Using the FRS, 20% of patients with CAD and 33% of patients with obstructive CAD were correctly identified as having high CV risk. For the modified FRS, the proportions increased to 43% and 56%, respectively.

About one-third (32%) of patients who were classified by the FRS as having low to intermediate CV risk were reclassified as having high risk, based on the presence of carotid plaque. Similarly, 30% of patients who were classified with low to intermediate CV risk by the modified FRS were reclassified to high CV risk based on the presence of carotid plaque.

Among patients with CAD, those with coronary plaques had significantly higher mean and maximum cIMT compared with the patients without coronary plaques. Although the prevalence of carotid plaque was similar among patients with and without CAD, there was a larger TPA in patients with CAD.

According to the authors, the findings demonstrate the low sensitivity of FDS, while increased cIMT and the extent of carotid plaque were associated with CAD. They added that “mean cIMT has the highest utility in identifying patients in need of further CV risk factor interventions.”

“While the presence of carotid plaque alone was insufficient to discriminate patients with PsA with or without CAD, a combination of FRS and cIMT may be considered for CV risk stratification in these patient,” the authors concluded.

Reference

Cheng IT, Wong KT, Li EK, et al. Comparison of carotid artery ultrasound and Framingham risk score for discriminating coronary artery disease in patients with psoriatic arthritis. RMD Open. 2020;6(3):e001364. doi:10.1136/rmdopen-2020-001364