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Abstract Number: 1596

Atherosclerotic Cardiovascular Disease in Psoriatic Arthritis: Evaluation of Risk Factor Management and Use of Aspirin and Statin for Prevention in a Primary Care Setting

Linh Truong1, Nicole Ridolfi1 and Maida Wong2,3, 1Internal Medicine, University of California, Irvine, Orange, CA, 2Department of Medicine, University of California, Irvine, orange, CA, 3Division of Rheumatology, Tibor Rubin Veterans Affairs Medical Center Long Beach, Long Beach, CA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Arteriosclerosis, Cardiovascular disease, prevention, Primary care and psoriatic arthritis

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Session Information

Date: Monday, October 22, 2018

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

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.


Disclosure: L. Truong, None; N. Ridolfi, None; M. Wong, None.

To cite this abstract in AMA style:

Truong L, Ridolfi N, Wong M. Atherosclerotic Cardiovascular Disease in Psoriatic Arthritis: Evaluation of Risk Factor Management and Use of Aspirin and Statin for Prevention in a Primary Care Setting [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). 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/. Accessed .
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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/

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