Increased Prevalence of Coronary Atherosclerosis in Psoriatic Arthritis

Patients with psoriatic arthritis (PsA) had an increased prevalence of coronary atherosclerosis despite not having a previous diagnosis of coronary artery disease, according to recent research published in the Annals of the Rheumatic Diseases.

Jiayun Shen, PhD, from the Department of Medicine & Therapeutics, at The Prince of Wales Hospital of The Chinese University of Hong Kong and colleagues evaluated coronary atherosclerosis in 90 patients with PsA against 240 matched patients in a control group, according to the abstract.

The PsA cohort was 62.2% male (n = 56) and participants were mean 50.3 ± 11.1 years of age without a history of cardiovascular (CV) or coronary artery disease (CAD), while the control group was 57.1% male (n = 137) and 49.6 ± 10.7 years of age. Age, gender, and CV factors were matched between PsA and control group patients.

“The take-away message is that this study has found that a large proportion of patients with PsA could be having silent CAD; therefore, a more aggressive CV evaluation strategy should be considered in patients with PsA, especially in patients with longer disease duration,” Lai-Shan Tam, MD, corresponding author from The Chinese University of Hong Kong, told Rheumatology Advisor in an interview.

The researchers found 60% of patients in the PsA group (n = 54) had a significantly higher prevalence of overall plaque compared with 35% (n = 84) of patients in the control group (P <.001).

Specifically, 32% (n = 29) of patients with PsA had a higher prevalence of calcified plaque compared with 17% (n = 40) of patients in the control group (P =.002); 22% of patients with PsA (n = 20) had a higher prevalence of mixed plaque compared with 8% (n = 18) of control patients ( P <.001), and 43% (n = 46) of patients with PsA had a higher prevalence of noncalcified plaque compared with 22% (n = 53) of control patients (P <.001).

Dr Shen and colleagues also found 51% of patients with PsA (n = 46) had a combination of mixed plaque and noncalcified plaque compared with 26% of patients (n = 62) in the control group (P <.001).

“Plaque burden and severity were also higher in patients with PsA,” Dr Tam said. “These differences were independent of traditional CV risk factors, supporting the hypothesis that PsA itself (inflammation) is an independent risk factor. In patients with PsA, besides age and gender, cumulative inflammatory burden as reflected by PsA disease duration was independently associated with the presence of high-risk plaque.”

PsA was an independent explanatory variable for all coronary plaque types (odds ratio [OR] = 2.730-4.064; P <.001), obstructive plaque (OR = 3.939 P <.001), and 3-vessel disease (OR = 10.798; P <.001).

The researchers diagnosed 3-vessel disease in 13% (n = 12) of patients with PsA and 3% (n = 7) of patients in the control group (P < .001), with 9% (n = 8) of patients with PsA and 3% (n = 7) of control patients having obstructive plaques (P = .033).

Summary & Clinical Applicability

“Various CV risk assessment scores have been reported to underestimate CV risk in patients with PsA,” Dr Tam said. “Detailed assessment of coronary atherosclerosis could improve risk stratification and may identify patients who need immediate aggressive intervention, such as percutaneous coronary intervention.”

Dr Tam said clinicians should seek to identify patients at risk for CVD and provide lifestyle advice and preventive treatment when appropriate.

“Antihypertensives and statins may be used as in the general population if indicated,” Dr Tam said. “Disease activity should be adequately controlled using disease-modifying antirheumatic drugs according to treatment target not only to minimize symptoms, but also to prevent CVD in the long-term.”

Reference

Shen J, Wong K-T, Cheng I, et al. Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease [published online January 4, 2017]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2016-210390

follow @RheumAdvisor