PsA Linked With Higher Prevalence of Cardiovascular Events, Risk Factors

Prevalence of cardiovascular risk factors (CVRFs) and cardiovascular events (CVEs) are higher in patients with psoriatic arthritis (PsA) vs the general population, although low-density lipoprotein (LDL) cholesterol levels did not differ between the groups. The results were published in Frontiers in Medicine.

PsA and other inflammatory diseases, such as rheumatoid arthritis (RA), have recently been listed by European Cardiology Association guidelines as inherent CVRFs associated with increased cardiovascular morbidity and mortality. In determining risk of CVEs, measurement of LDL cholesterol levels have been recommended by European guidelines.

“Control of CVRFs is essential. This is exemplified by the decrease in CVEs in patients with RA and PsA treated with statins,” wrote the study authors.

They conducted an observational cross-sectional monocentric case-control study among patients with PsA and matched controls from the general population to compare prevalence of CVRFs, CVEs, the cardiovascular risk (CVR), and the proportion of individuals in both populations who reach the recommended LDL cholesterol level and are treated with statins.

A total of 207 patients with PsA aged 25 to 85 years (mean [SD] age, 54.7 [11.4] years) who met the Classification for Psoriatic Arthritis (CASPAR) criteria and 414 controls (mean [SD] age, 54.8 [10.7] years) extracted from the MOnitoring NAtionaL du rISque Artériel (MONALISA) study were included in the analysis.

“The CVR was first assessed using SCORE and QRISK2 equations. Then, the SCORE equation was corrected by applying a 1.5 multiplication factor, as recommended by the European League Against Rheumatism (EULAR) for RA (SCORE-PsA), and the QRISK2 was corrected using the RA item (QRISK2-PsA),” explained the study authors.

After controlling for age and gender, patients with PsA exhibited higher CVRFs vs controls (body mass index, prevalence of hypertension, triglycerides, C reactive protein (CRP), prevalence of smoking, and prevalence of metabolic syndrome). Compared with controls, patients with PsA additionally had lower levels of LDL cholesterol, high-density lipoprotein cholesterol, and total cholesterol serum creatinine (all, P < .001), as well as a lower prevalence of dyslipidaemia (P = .001).

Atherothrombotic disease was increased in the PsA population (SCORE, P = .002; QRISK2, P = .001), whereas prevalence of myocardial infarction, stroke, and obliterating arteriopathy of the lower limbs was numerically higher in these patients but without statistically significant difference.

Use of the SCORE-PsA metric increased the percentage of patients with a high or very high CVR from 39.3% to 45.3% in the PsA group, and use of the QRISK2-PsA metric increased the percentage of patients with a CVR greater than or equal to 10% from 44.9% to 53.2%.

The percentages of patients with PsA with high LDL cholesterol in the high and very high CVR groups were not significantly different from controls, despite a trend in favor of patients with PsA, the authors noted. Of the 83 patients with PsA with a QRISK2 greater than or equal to 10%, only 22.9% were treated with statin vs 35.8% of the 134 controls. The QRISK2-PsA score did not alter these results.

The lack of patients with PsA and controls at high or very high CVR who reached the LDL cholesterol target or were treated with statins highlights an unmet need for treatment optimization, concluded researchers.

Reference

Degboé Y, Koch R, Zabraniecki L, et al. Increased cardiovascular risk in psoriatic arthritis: Results from a case-control monocentric study. Front Med. Published online May 19, 2022. doi:10.3389/fmed.2022.785719