Psoriatic Arthritis, Cardiovascular Disease Link Confirmed

Nicola M. Parry, DVM

May 10, 2016

Patients with psoriatic arthritis (PsA) may be at increased risk for experiencing significant cardiovascular (CV) events, a new study suggests.

"[T]hese findings support the notion that PsA should be considered as an independent risk factor for cardiovascular diseases," write Ari Polachek, MD, from the University of Toronto, Ontario, Canada, and colleagues. They published the results of their systematic review and meta-analysis online April 25 in Arthritis Care & Research.

"We have found that patients with PsA had a 43% higher risk of having (or developing) cardiovascular diseases compared to non-psoriatic individuals while the risk of developing an incident cardiovascular event was 55% higher in PsA patients compared with the general population," the authors write. "Furthermore, the risk of each of the individual cardiovascular outcomes was increased, including [myocardial infarction] (68%), cerebrovascular diseases (22%) and heart failure (31%) in PsA."

Several reports have suggested an association between psoriatic disease and comorbidities, in particular CV and metabolic comorbidities. However, among studies that have examined the risk for CV events in patients with PsA in particular, results have been conflicting. Dr Polachek and colleagues therefore aimed to provide an updated synthesis of the evidence from all available studies of CV risk in patients with PsA.

The researchers performed a systematic review of currently available observational studies to assess the size of the risk for incident and prevalent CV and cerebrovascular diseases in patients with PsA and compare it with the risk in individuals in the general population.

They searched various electronic databases to identify primary studies for inclusion. They excluded studies that did not include a control population without psoriasis and rheumatic conditions, as well as those that did not assess CV outcomes. Case-control, cross-sectional, and cohort studies were included if they evaluated patients with PsA, assessed CV outcomes, and involved a comparison group of individuals without psoriasis or rheumatic diseases.

Eleven studies met the inclusion criteria and involved 32,973 patients with PsA.

Overall, patients with PsA had a 43% higher risk for CV disease than did individuals in the general population (pooled odds ratio [OR], 1.43; 95% confidence interval [CI], 1.24-1.66). They also had a 55% higher risk for incident CV events (pooled relative risk [RR], 1.55; 95% CI, 1.22-1.96).

"The 55% increase in the risk of incident cardiovascular events in PsA patients highlights the limitations of current risk stratification strategies that are based on clinical risk algorithms, such as the Framingham risk score," the authors write. "These algorithms were found to underestimate the actual cardiovascular risk in patients with chronic inflammatory conditions, including psoriasis and PsA, as they do not consider the independent risk entailed with the chronic inflammatory process. Nevertheless, aggressive primary cardiovascular risk prevention should be part of standard of care in patients with PsA."

They conclude, "Overall, these findings support the notion that PsA should be considered as an independent risk factor for cardiovascular diseases."

Dr Polachek was supported by a Fellowship Grant from Janssen, Canada. One of the other coauthors was supported by the Krembil Foundation and a Canadian Institutes of Health Research fellowship award. The other coauthors have disclosed no relevant financial relationships.

Arthritis Care Res. Published online April 25, 2016. Abstract

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