Background/Purpose: Rheumatoid Arthritis (RA) is associated with increased cardiovascular mortality and morbidity rates. Similarly several studies have reported an increased risk for cardiovascular events in patients with psoriasis. There, however, are few studies that have reported on the risk factors for major adverse cardiovascular events (MACE) in patients with psoriatic arthritis (PsA). Furthermore, no studies have compared the risk for MACE in PsA patients with RA patients.

Objective:To determine if the prevalence and risk factors for MACE in PsA patients and compare with prevalence and risk factors for MACE in RA patients.

Methods: All patients with RA and PsA with at least one follow up visit were identified from the Consortium of Rheumatology Researchers of North America (CORRONA) database. The incident rates (IR) for MACE per 100 person years of follow up were estimated. MACE was defined as myocardial infarction, stroke/ transient ischemic attacks and death secondary to cardiovascular events.  Follow up time was counted from enrollment in CORRONA to the first reported event or the last follow up. Cox regression models estimated the association of the following covariates with MACE rates: age, gender, body mass index (BMI), physician global assessment of disease activity (PGDA), disease duration, bone erosion status, disease modifying anti-rheumatic drugs, steroids, aspirin, smoking, diabetes, and hypertension.

Results: A total of 25,700 RA patients (81,104 person years of follow-up) and 3,909 PsA patients (11,828 person years of follow-up) were identified. Patients with RA were older, had a lower BMI, higher MD global assessment scores, longer disease duration, were less likely to have diabetes and less likely to be on biologic therapies but more likely to be on DMARDs or steroids than PsA patients. The percentage of previous and current smokers was similar between RA and PsA patients. The unadjusted IR for MACE events in RA and PsA patients were 0.65 (95% CI: 0.60-0.71) and 0.35 (CI: 0.25-0.47) respectively. The unadjusted IR for MACE events was higher in RA patients with erosions (0.71, 0.61-0.81) compared with those without erosions (0.53, 0.45-0.63) but in PsA patients the IR was slightly higher in those without erosions (0.33, 0.19-0.55) than in those with erosions (0.25, 0.10-0.51). Age, gender, history of hypertension, disease duration, steroids, diabetes and PGDA were identified as significant risk factors for MACE in the RA population. In contrast, in PsA patients, age, hypertension, gender and PGDA were the only risk factors.

Conclusion: Unadjusted MACE events are more common in RA than in PsA. Only age, gender, hypertension, and PGDA were common risk factors to both forms of arthritides, although events and follow up time in PsA patients limited the number of multiple covariates that could be examined.

Table 1: Hazard Ratios (HR) from Multivariate Cox Regression Models in RA and PsA patients
	HR for risk of MACE events
	RA patients	PsA patients
Female	0.55  [0.46, 0.67]	0.41  [0.21, 0.80]
Age    <50   50-60   60-70   ≥70	1 2.16  [1.46, 3.19] 3.52  [2.41, 5.15] 7.07  [4.85, 10.30]	1 3.32  [1.05, 10.51] 8.61  [2.76, 26.91] 8.75  [2.46, 31.05]
Smoking status     Never     Previous     Current	1 1.19  [0.95, 1.48] 2.28  [1.81, 2.86]	1 1.74  [0.85, 3.56] 2.55  [1.06, 6.11]
History of Hypertension	1.39  [1.16, 1.67]	2.08  [1.07, 4.03]
MD global assessment (risk per unit change)	1.006  [1.002, 1.010]	1.018  [1.003, 1.033]
History of diabetes	1.59  [1.22, 2.07]	1.08  [0.46, 2.51]
Duration of disease (risk per yr)	1.016  [1.008, 1.024]
Steroid use	1.55  [1.30, 1.86]

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/major-adverse-cardiovascular-events-are-more-common-in-rheumatoid-arthritis-than-in-psoriatic-arthritis-and-are-associated-with-different-risk-factors/