Cardiovascular risk and subclinical atherosclerosis in a psoriatic arthritis cohort

Abstract

Abstract: 

INTRODUCTION: Psoriatic arthritis (PsA) is a chronic and inflammatory disease associated with higher cardiovascular morbidity and mortality compared to the general population. Currently, it is considered an independent risk factor for cardiovascular (CV) diseases.

OBJECTIVE: To evaluate the cardiovascular risk profile and the presence of subclinical atherosclerosis in patients with PsA.

MATERIAL AND METHODS: A cross-sectional study was performed between July / 2019-2020. Patients with PsA were included according to Caspar criteria. Demographic data, comorbidities, duration of the disease and involved domains were analyzed. Disease activity was evaluated by PASI, BSA and DAPSA, considering remission by DAPSA and MDA. CV risk was stratified according to SCORE. Subclinical atherosclerosis (ATEsc) and it was defined by carotid ultrasound, with the presence of myointimal thickening and atherosclerotic plaque. Patients with a previous cardiovascular event were excluded. Continuous variables analyzed were median and interquartile ranges, and categorical as frequency and percentage.

RESULTS: 42 patients were included. The median age was 54.50 years (41.75-60.75), with 60% of women. 48% of patients were obese, 36% hypertensive, 31% Hyperlipidemia, 24% diabetic, and 19% smokers. The median duration of psoriasis was 16 years (6.75-23.75), while APs was 12 months (12-72). 83% (34) had polyarticular peripheral involvement, 26% (11) axial, 63% (26) nail, 31% (13) dactylitis and 26% (11) enthesitis. 28% (11/40) of the patients presented MDA and 8% (3/40) remission. 80.5% (33/41) presented moderate CV risk and 19.5% (8/41) high-very high. 31.5% (38/42) of the patients had ATEsc. The group with high CV risk was significantly associated with the presence of ATEsc (p = 0.01). We not found a relationship between ATEsc and the absence of classic CV risk factors, involved domains, or disease activity.

CONCLUSION: In our study, we found a high risk for the cardiovascular events with the presence of subclinical atherosclerosis in one third of the patients. The evaluation of cardiovascular risk and management of comorbidities in individuals with PsA is essential