Background/Purpose:

There is accumulating evidence that shows an increased prevalence of atherosclerotic cardiovascular disease (ASCVD) risk factors among the psoriatic arthritis (PsA) population. The aim of this study is to assess the ASCVD morbidity in PsA and the management of this group’s ASCVD risk according to national guidelines in the primary care setting.

Methods:

A retrospective study at a Veterans Affairs Hospital involving PsA patients (n=99) and controls (n=99) without autoimmune diseases was performed. The groups were matched on age, sex, race, BMI and ASCVD risk factors (hypertension, diabetes, and hyperlipidemia). Their ASCVD risk was evaluated using the American College of Cardiology/American Heart Association’s (ACC/AHA) ASCVD risk score. The odds ratio (OR) for myocardial infarctions (MI), congestive heart failure (CHF), and cerebral vascular accidents (CVA) were calculated. The yearly ASCVD management outcomes in a primary care setting, averaged over five years, were evaluated according to the frequency of primary care provider (PCP) visits, laboratory checks for Hgb A1c and lipid profile, non-pharmacological ancillary referrals, and use of cardio-protective supplements like niacin and fish oil. The appropriate statin intensity prescribed, and the use of aspirin (ASA) and statin for primary and secondary ASCVD prevention according to the the US Preventative Services Task Force (USPSTF) and ACC/AHA guidelines were also evaluated.

Results:

PsA and controls have an ASCVD risk score of 23.8% and 17.1% (p=0.003). PsA patients have twice the risk for developing ASCVD events (OR 2.18; 95% CI 1.19 to 3.98). CHF (OR 4.17; 95% CI 1.48 to 11.75) was the most likely event to develop when compared to CVA (OR 2.03; 95% CI 0.82 to 5.03) or MI (OR 1.72; 95% CI 0.89 to 3.29). PsA patients had similar, if not worse, average yearly PCP visits (1.0 vs 1.4), A1c checks (2.3 vs 1.2), and lipid panel checks (1.2 vs 1.2). Fewer PsA patients received non-pharmacological ancillary referrals (6% vs 69%) and cardio-protective supplements (7% vs 11%). In PsA patients, ASA was underutilized for primary (0% vs. 26%; p=0.018) and secondary prevention (52% vs. 60%; p=0.25). Similarly, statin therapy was underutilized (37% vs. 60%; p=0.006) (40% vs. 86%; p=0.009) and the statin intensity prescribed was often inappropriate (28% vs 63%; p=0.0001).

Conclusion:

PsA patients have an increased risk for developing ASCVD and yet, receive worse risk factor management by PCPs. The use of ASA and statin is underutilized in PsA, and the statin intensity prescribed to this group is inadequate according to current national guidelines. Additional studies are warranted to elucidate whether shifting the responsibility of managing ASCVD risk from PCPs to rheumatologists, or providing greater education to PCP on this topic could improve ASCVD outcomes in the PsA population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/atherosclerotic-cardiovascular-disease-in-psoriatic-arthritis-evaluation-of-risk-factor-management-and-use-of-aspirin-and-statin-for-prevention-in-a-primary-care-setting/