Meta-Analysis Estimates Magnitude of Increased Cerebrovascular, Cardiovascular Morbidity in PsA

TOPIC SERIES: CVD PREVENTION IN RHEUMATIC DISEASE

Patients with psoriatic arthritis (PsA) have a 43% higher risk of having or developing cardiovascular diseases (CVD) and a 22% higher risk of developing cerebrovascular disease compared with the general population, according to research published in Arthritis Care & Research. These findings suggest that PsA may be an independent risk factor for CVD.

There is a well-known association between PsA and CVD morbidity. The exact magnitude of increased risk, however, had previously not been analyzed by meta-analysis.

“Currently, no specific recommendations for CV risk prevention in patients with PsA exist…quantification of the excess CV risk in PsA has clinical implications and is of considerable importance”, the authors stated.

In the first meta-analysis to estimate the magnitude of CVD and cerebrovascular disease risk among patients with PsA compared with the general population, Ari Polachek, MD, from the University of Toronto, Ontario, Canada, and colleagues conducted a systematic meta-analysis of medical databases and archives of patients diagnosed with PsA.

Meta-analysis inclusion search parameters included 2 search blocks, the first being for the terms “psoriasis”, “psoriatic arthritis“, “spondyloarthritis“, or “seronegative spondyloarthropathy”, and the second for synonyms of cardiovascular and cerebrovascular disease.  Published research included case-control, cross-sectional, and cohort studies

Researchers defined angina, ischemic heart disease, coronary artery disease, and myocardial infarction (MI) as end-points for CVD.  Stroke or transient ischemic attack were defined as cerebrovascular disease endpoints. 

Eleven studies meeting the inclusion criteria included 32,973 patients with PsA were analyzed and showed a 43% increased risk for CVD among those with PsA compared with the general population (pooled odds ratio [OR] 1.43; 95% confidence interval [CI] 1.24-1.66).

There was a 68% increased risk for morbidity associated with MI in patients with PsA  (pooled OR, 1.68; 95% CI1.31-2.15), a 22% increased risk for cerebrovascular disease (pooled OR, 1.22; 95% CI 1.05-1.41), and a 31% increased risk for heart failure (pooled OR, 1.31; 95% CI 1.11-1.55). Significant heterogeneity was found among all main analyses. 

Summary and Clinical Applicability

Patients with PsA had a 43% increased risk for CVD morbidity and a 22% increased risk for cerebrovascular morbidity. 

“The magnitude of the elevated [CVD] risk was similar to that observed in patients with severe psoriasis. These findings support the notion that PsA is an independent risk factor for cardiovascular diseases,” the authors concluded.

Limitations and Disclosures

These findings were limited by the inclusion of both cross-sectional and cohort studies in the data analsyis, further contributing to the data heterogeneity.

“Additional sources of heterogeneity included different clinical settings, case definitions of PsA, definitions of outcomes, modes of events ascertainment and the degree of adjustment for potential confounders,” the authors noted.

Reference

Polachek A, Touma Z, Anderson M, Eder L. Risk of cardiovascular morbidity in patients with psoriatic arthritis: A meta-analysis of observational studies. Arthritis Care Res (Hoboken). 2016; Accepted Article published online ahead of print doi: 10.1002/acr.22926