Disease Activity Tool, Carotid Plaque Predicts Cardiovascular Events in Patients with Psoriatic Arthritis

Higher Disease Activity in Psoriatic Arthritis (DAPSA) and the presence of carotid plaque are associated with increased risk for cardiovascular disease (CVD) events in patients with psoriatic arthritis (PsA), according to study results published in Annals of the Rheumatic Diseases.

Previous studies have suggested an increased risk for CVD in patients with PsA; therefore, the objective of the current study was to determine whether there is an association between DAPSA and subclinical carotid atherosclerosis and risk for CVD, independent of traditional CVD risk factors.

Framingham Risk Score (FRS), QRISK3 algorithm, Systematic Coronary Risk Evaluation (SCORE), and 10-year atherosclerotic CVD risk algorithm (ASCVD) were used to quantify the risk for CVD at baseline. A high-resolution ultrasound was used to determine the presence of carotid plaque and intimamedia thickness.

The study cohort included 189 patients with PsA (mean age, 48.9 years; 55.0% men) who were followed up since 2006. The primary outcome was first CV event, including ischemic heart disease, stable and unstable angina, myocardial infarction, transient ischemic attack, coronary insufficiency, peripheral arterial disease, stroke, and cardiovascular mortality.

After a median follow-up of 9.9 years, 27 patients (14.3%) developed a first CV event (1.6 events per 100 patient-years), including 14 (51.8%) ischemic heart disease, 5 (18.5%) myocardial infarction, 2 (7.4%) transient ischemic attack, 3 (11.1%) stroke, 1 (3.7%) congestive heart failure, and 2 (7.4%) coronary angioplasty for obstructive ischemic heart disease.

Statistical analysis showed an association between increasing DAPSA and higher risk for CV events over time (hazard ratio, 1.04; 95% CI, 1.01-1.08; P =.009). The association remained significant after adjustment for all CV risk scores.

A total of 154 (mean age, 49.4 years; 58.4% men) patients received carotid ultrasound assessment. Of these, 23 (14.9%) patients experienced a first CV event (1.7 events per 100 patient-years). The presence of carotid plaque was associated with an increased risk for CVD, independent of DAPSA, with hazard ratios of 2.35 (95% CI, 1.02-5.42) after adjustment for FRS, 2.60 (95% CI, 1.14-5.96) after adjustment for ASCVD, 2.93 (95% CI, 1.29-6.67) after adjustment for QRISK3, and 3.42 (95% CI, 1.54-7.56) after adjustment for SCORE.

Study limitations included the relatively small number of patients with CVD, missing data on total plaque area, plaque vulnerability and vascular inflammation, and the lack of assessment of the effect of systemic steroids on CV risk.

“[T]his study shows that inflammatory burden as reflected by DAPSA and the presence of [carotid plaque] could independently predict CV events in addition to traditional CV risk factors,” the researchers concluded.

Reference

Lam SHM, Cheng IT, Li EK, et al. DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study. Published online July 31, 2020. Ann Rheum Dis. doi:10.1136/annrheumdis-2020-217595