Risk factors for predicting cardiac events are different in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis, indicating that cardiovascular risk reduction strategies should be disease-specific rather than universal, according to a study published in Seminars in Arthritis and Rheumatism.1
Data have demonstrated that patients with inflammatory conditions, such as RA, psoriasis, and PsA, have higher incidences of cardiovascular events.2-10 However, this risk cannot be explained by traditional cardiovascular risk factors alone, and systemic inflammation is independently associated with increased cardiovascular risk.11,12
To better define cardiovascular risk in these populations, researchers examined Welsh health data from 1999 to 2013 to compare the incidence of major adverse cardiac events among patients with RA (n=8650), PsA (n=2128), and psoriasis (n=24,630) with controls (n=1,187,706).1 They found that traditional cardiovascular risk factors are higher among patients with RA, PsA, and psoriasis than control patients.
Additional increased cardiovascular risk was only statistically significant in female patients with RA (P =.05) and in patients with psoriasis (P =.02), but was not significant for patients with psoriatic arthritis (P =.13).
Systemic inflammation was higher in patients with rheumatoid arthritis but not in patients with psoriasis, indicating that there are varying mediators of cardiovascular risk across these conditions.
This is the first study to demonstrate that patients with psoriasis are at greater risk for major adverse cardiac events similar to patients with rheumatoid arthritis, even after controlling for traditional cardiovascular risk factors, which suggests that additional factors contribute to the development of cardiovascular events in these conditions.1
“Distinct factors are responsible for cardiovascular events in different chronic inflammatory diseases and as such cardiovascular risk reduction strategies need to be disease specific and not standard across these conditions,” the authors concluded.
- Cooksey R, Brophy S, Kennedy J, et al. Cardiovascular risk factors predicting cardiac events are different in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis [published online March 17, 2018]. Semin Arthritis Rheum. doi: 10.1016/j.semarthrit.2018.03.005
- Meune C, TouzeE, Trinquart L, Allanore Y. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology. 2009;48:1309-1313.
- Kristensen SL, McInnes IB, Sattar N. Psoriasis, psoriatic arthritis and cardiovascular risk: are we closer to a clinical recommendation? Ann Rheum Dis. 2015;74:321-322.
- Miller IM, Ellervik C, Yazdanyar S, Jemec GB. Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors. J Am Acad Dermatol. 2013;69:1014-1024.
- Belinchon I, Vanaclocha F, de la Cueva-Dobao P, et al. Metabolic syndrome in Spanish patients with psoriasis needing systemic therapy: Prevalence and association with cardiovascular disease in PSO-RISK, a cross-sectional study. J Dermatolog Treat. 2015;26:318-325.
- Edson-Heredia E, Zhu B, Lefevre C, et al. Prevalence and incidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using Clinical Practice Research Datalink. J Eur Acad Dermatol Venereol. 2015;29:955-963.
- Calamita AB, Calamita Z, Braga JC. Risk factors for cardiovascular disease in psoriasis: relation to inflammation assessed by the severity and duration of illness. Inflamm Allergy Drug Targets. 2013;12:385-390.
- Torres T, Sales R, Vasconcelos C, Martins da Silva B, Selores M. Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: implications in cardiovascular risk factors management and primary prevention of cardiovascular disease. J Dermatol. 2013;40:923–6.
- Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. J Am Med Assoc. 2006;296:1735-1741.
- Gelfand JM, Dommasch ED, Shin DB, et al. The risk of stroke in patients with psoriasis. J Invest Dermatol. 2009;129:2411-2418.
- Dessein PH, Joffe BI, Veller MG, et al. Traditional and nontraditional cardiovascular risk factors are associated with atherosclerosis in rheumatoid arthritis. J Rheumatol. 2005;32:435-442.
- Graf J, Scherzer R, Grunfeld C, Imboden J. Levels of C-reactive protein associated with high and very high cardiovascular risk are prevalent in patients with rheumatoid arthritis. PLoS One. 2009;4:e6242.