Carotid Ultrasound Improves CV Risk Stratification for Psoriatic Diseases

The use of vascular imaging data, combined with traditional cardiovascular (CV) risk factors, may improve the accuracy in prediction of CV events in patients with psoriatic disease, according to research published in Arthritis and Rheumatology.

Researchers examined whether evaluation of subclinical atherosclerosis via carotid ultrasound could effectively predict incident CV events in patients with psoriatic disease. In addition, the researchers sought to determine if the incorporation of imaging data might improve Framingham Risk Score CV risk predictions.

Participants in a cohort analysis (N = 559) with psoriatic disease underwent ultrasound assessment of carotid arteries. Carotid intima media thickness and total plaque area were used to determine the extent of atherosclerosis. Incident CV events, either new or recurrent, were identified. In total, 42 patients with potential CV events were identified, of whom 23 had cardiologist-confirmed CV events, 19 of which were classified as major events. Cardiovascular events included myocardial infarction (10 patients), stroke (5 patients), revascularization (12 patients), chronic heart failure exacerbation (3 patients), angina (7 patients), and transient ischemic attack (1 patient).

At baseline, a majority of patients had atherosclerotic plaques (27% unilateral and 31.5% bilateral). Mean total plaque area was 0.18 ± 0.3 cm², and mean carotid intima media thickness was 639 ± 136 mm.

The rate of development for the first CV event and first major CV events was 1.11 (95% CI, 0.74-1.67) events per 100 patient-years and 0.91 (95% CI, 0.57-1.43) events per 100 patient-years, respectively.

A univariate regression analysis examining the association between baseline measures of atherosclerosis and incident CV events found a significant association between all atherosclerosis measures and incident CV events. A multivariable analysis, which controlled for Framingham Risk Score category, found that the association was attenuated but remained statistically significant for most measures of atherosclerosis.

A second multivariable regression analysis was performed with the addition of total plaque area and carotid intima media thickness in addition to the Framingham Risk Score category; this analysis remained statistically significant for total plaque area (hazard ratio [HR] 2.85; 95% CI, 1.19-6.82; P =.02) but was no longer significant for mean intima media thickness (HR 1.12; 95% CI, 0.93-1.34).

Several study limitations were noted, including the small number of CV events and the evaluation of only structural aspects of atherosclerosis burden.

The researchers of the study concluded that “the burden of carotid atherosclerosis… predicts future incident [cardiovascular events] in patients with [psoriatic disease] independent of a traditional clinical cardiovascular risk prediction algorithm. Combining vascular imaging data with clinical and laboratory measures of traditional cardiovascular risk factors could improve accuracy of cardiovascular risk stratification in patients with [psoriatic disease] and facilitate earlier initiation of appropriate treatment to reduce [cardiovascular events] in this population.”

Reference

Sobchak C, Akhtari S, Harvey P, et al. The value of carotid ultrasound in cardiovascular risk stratification in patients with psoriatic disease [published online June 5, 2019]. Arthritis Rheumatol. doi:10.1002/art.40925