Background/Purpose: Patients with psoriatic arthritis (PsA) and psoriasis (PsO) are at increased risk of cardiovascular diseases (CVD) and the risk is higher in patients with severe disease phenotypes^1,2. A population based study has suggested that PsA, PsO and RA have similar risks for the development of major CV events, therefore CV risk should be addressed in all patients affected by these conditions³. The association between psoriatic disease and CV morbidity is poorly understood and studies estimating long-term risk of CVD in PsA and PsO are scarce.The aim of the study was to compare CV risk factors and 10-year CVD risk scores between patients with PsA to those with PsO alone.

Methods: PsA patients fulfilling the CASPAR criteria and PsO with disease duration <10 years were enrolled consecutively from Rheumatology and Dermatology clinics. Fasting bloods were obtained for glucose, insulin, lipids, homocysteine and NT-proBNP. Detailed medical history including items related to comorbidities and known risk factors was taken. Patients underwent thorough physical examination, joint and skin assessments and completed questionnaires on health and quality of life on ipads using a web-based tool. We compared risk factors for CVD between PsA and PSO patients and assessed 10-year CV risk using the Atherosclerotic Cardiovascular Disease (ASCVD) and Framingham Risk Score (FRS). Multiple regression analyses were performed to evaluate the effect of traditional risk factors not included in ASCVD and FRS and disease-related parameters on 10-year CV risk.

Results: 162 patients (100 PsA and 62 PsO) were recruited with mean age 52 (±10.4) for PsA and 40 (±14.7) years for PsO. Mean disease duration for PsA was 17.9 (±10) years. There were significantly more patients with hypertension and metabolic syndrome in the PsA group, and the waist/hip ratio, the number of smokers and patients taking DMARDs and/or biological treatment were also higher compared to PsO. The mean FRS and ASCVD were significantly higher in PsA as compared to PsO (6.04± 6.4% vs. 3.24±5.5%, P=0.007; 6.97±8% vs. 3.98±5%, P=0.008, respectively). Multiple regression analysis revealed that waist/hip ratio had significant effect on FRS and HOMA-R had significant relationship with ASCVD in both diseases. After adjustment for age and sex, we found higher proportion of patients with hyperlipidaemia (P=0.02) and insulin resistance with higher mean HOMA-R in PsO, however FRS and ASCVD scores were similar. We found that HOMA-R and treatment did not show association with 10-year CV risk, and that waist/hip ratio, but not BMI had significant effect on FRS in PsO (β=0.36, P=0.01).

Conclusion: We found similar 10-year risk of CVD in PsA and PsO patients using FRS and ASCVD and that waist/hip ratio had significant effect on FRS. Our results highlight the value of measuring waist/hip ratio and suggest that traditional modifiable risk factors, such as central obesity should be managed appropriately to reduce long-term CVD in psoriatic disease. References:

1. Haroon M. JRheumatol 2014
2. Eder L. Ther Adv Musculoskel Dis 2015
3. Ogdie A. ARD 2015

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-10-year-cardiovascular-disease-assessed-by-framingham-risk-score-is-similar-in-patients-with-psoriatic-arthritis-and-psoriasis-as-assessed-by-atherosclerotic-cardiovascular-disease-and-framing/