An increased prevalence of risk factors associated with cardiovascular disease documented in a large database of patients with psoriatic arthritis (PsA) includes related comorbidities such as valvular lesions and cardiomyopathy, according to a study published in Clinical Rheumatology. Therefore, clinicians should be aware of the increased risk in this population and screen for risk factors such as hyperlipidemia, hypertension, and type 2 diabetes.
This retrospective case control study analyzed data from 2000 to 2013 from Israel’s largest clinical patient database. For each of the 3161 patients with PsA (average age 58 ±15.0 years; 53.4% women), 10 age- and sex-matched patients without a history of psoriasis or arthritis were analyzed. Cardiovascular disease-related risk factors and morbidities assessed included hyperlipidemia, hypertension, type 2 diabetes, smoking, congestive heart failure, obesity, ischemic heart disease, cerebrovascular accident, aortic aneurism, peripheral vascular disease, carotid artery disease, valvular heart disease, and cardiomyopathy. A t-test and chi-squared tests were used for statistical analysis as appropriate, and the association between PsA and CVD risk factors and morbidities were assessed using univariate and adjusted multivariable logistic regression models.
Compared with the control group, the PsA group showed increased prevalence of hyperlipidemia (odds ratio [OR] 1.54; 95% CI, 1.43-1.67; P <.0001), obesity (OR, 1.71; 95% CI, 1.58-1.84; P <.0001), hypertension (OR, 1.51; 95% CI, 1.40-1.62; P <.0001), and type 2 diabetes (OR, 1.48; 95% CI, 1.36-1.61; P <.0001). Even after adjusting for CVD-related risk factors, the PsA group showed significantly increased prevalence of peripheral vascular disease (OR, 1.28; 95% CI, 1.06-1.53; P =.009), ischemic heart disease (OR, 1.30; 95% CI, 1.17-1.46; P <.0001), congestive heart failure (OR, 1.20; 95% CI, 1.02-1.42, P =.033), and cardiomyopathy (OR, 1.45; 95% CI, 1.03-2.03; P =.033) compared with the control group, although this difference was no longer statistically significant after adjusting for patient demographics.
Limitations to this study include an inability to assess the association between psoriatic arthritis and specific subtypes of cardiomyopathy or valvular heart lesions, a cross-sectional design, and a lack of data on psoriatic disease severity.
Investigators concluded that the study “extends the spectrum of cardiac-related comorbidities to include cardiomyopathy and valvular lesions. Clinicians caring for PsA patients should be aware of the increased risk of CVD-associated morbidity in PsA patients, confirmed in different regions worldwide, and screen patients with PsA for CVD-related risk factors such as [hypertension], [hyperlipidemia], and [type 2 diabetes]. Further research is needed to explore new risk stratification methods for calculating CVD risk in PsA patients.”
Kibari A, Cohen AD, Gazitt T, et al. Cardiac and cardiovascular morbidities in patients with psoriatic arthritis: a population-based case control study [published online April 1, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04528-y