VBCR - February 2015, Volume 4, No 1 - In the Literature

People with psoriatic arthritis (PsA) are at increased risk for cardiovascular disease (CVD) even at early stages of PsA, but the traditional method of estimating risk using the Framingham risk score (FRS) appears to greatly understimate the true risk of CVD in this population. A new study suggests that the FRS may underestimate CVD risk by as much as 50% in newly diagnosed patients with PsA.

The population-based, retrospective study included 158 patients who fulfilled the ClASsification of Psoriatic ARthritis (CASPAR) criteria for PsA between 1989 and 2008. Mean age was 43.4 years (range, 19-74 years); 61% were men; 44% were obese (body mass index ≥30 kg/m2); and 94% had inflammatory joint disease. Fifty-four patients (34%) had at least 2 CVD risk factors at diagnosis of PsA. Medical records were reviewed to identify CVD risk factors and CVD events, and future risk of CVD was estimated using the FRS algorithm.

The 10-year risk of CVD was twice as high in PsA patients as that predicted by the FRS, especially for patients older than 40 years. Over 1 year of follow-up, 32 patients had at least 1 cardiovascular event, for a 17% 10-year cumulative incidence—twice as high as the incidence predicted by the FRS.

Of 126 PsA patients aged 30 years or older with no CVD history, 18 developed CVD for a cumulative incidence of 17%—also twice as high as that predicted by the FRS.

No differences between the groups were found for traditional CVD risk factors (ie, cholesterol level, smoking history, obesity, and blood pressure) and the FRS was not associated with disease activity as measured by traditional markers such as erythrocyte sedimentation rate.

The authors comment that the association between rheumatoid arthritis and CVD is well established, and risk factors such as disease activity, corticosteroid use, and inflammation have been implicated in the acceleration of CVD in this population. However, these associations are less well understood and studied in PsA, and subclinical atherosclerosis has been detected in PsA patients without traditional cardiovascular risk factors. The authors believe that the presence of PsA alone may account for increased CVD risk.

Limitations of the study include lack of a comparator group and relatively short follow-up.

Ernste FC, et al. Arthritis Care Res (Hoboken). Published online: January 7, 2015.

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Last modified: May 21, 2015
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