Cardiac Biomarkers and Carotid Atherosclerosis and Its Progression in Psoriatic Disease

Lihi Eder¹, Vinod Chandran², Iain B. McInnes³, Richard J. Cook⁴, Dafna D Gladman⁵, Paul Welsh⁶, Naveed Sattar⁷ and Paula Harvey⁸, ¹Women's College Research Institute, University of Toronto, Women's College Hospital, Toronto, ON, Canada, ²Krembil Research Institute & University of Toronto, Toronto, ON, Canada, ³University of Glasgow, Glasgow, United Kingdom, ⁴Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada, ⁵Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ⁶nstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom, ⁷Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom, ⁸Cardiology, Women's College Hospital, University of Toronto, Toronto, ON, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Atherosclerosis, Biomarkers, Cardiovascular disease, psoriasis and psoriatic arthritis

Session Information

Date: Monday, October 22, 2018

Session 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: Laboratory biomarkers indicative of cardiac ischemia or dysfunction improve cardiovascular (CV) risk stratification in the general population. Their utility in patients with psoriatic disease (PsD) is unknown. Our objective was to evaluate the levels of cardiac biomarkers in patients with PsD vs. non-psoriatic controls and to assess their association with the burden of carotid atherosclerosis and plaque progression.

Methods: Patients with psoriasis only (PsC) or psoriatic arthritis (PsA) from a longitudinal PsD cohort were enrolled. Non-psoriatic controls were recruited through advertisements and from hospital personnel. Baseline evaluation included clinical assessment of CV risk factors, joint and skin disease activity and medication use. Ultrasound assessment of the carotid arteries was performed only in patients with PsD. Total Plaque Area (TPA) was measured at baseline and after 2-3 years. The average annual progression rate of atherosclerosis was calculated by subtracting the baseline from the follow-up TPA divided by the number of years between the visits. Concentrations of high sensitivity Troponin I (TNT-I) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using automated clinical assays. The association between cardiac biomarkers and carotid atherosclerosis was assessed by multivariable regression analysis after adjusting for age, sex, diabetes, hypertension, smoking, BMI, lipid lowering therapy, LDL-c, HDL-c and creatinine.

Results: A total of 391 patients with PsD (71% PsA, 29% PsC) and 88 controls were included. Their mean age was 54.1±11.7 years (53.4% men). Unadjusted levels of TNT-I were higher in patients with PsD compared to controls (Odd Ratio (OR) 1.41, 95% Confidence Interval (CI) 1.11, 1.81), however, after controlling for age, sex and creatinine levels, no significant differences were found. The unadjusted and adjusted levels of NT-proBNP were similar in patients with PsD and controls. Higher levels of NT-Pro-BNP were associated with PsA vs. PsC (adjusted OR 1.35, 95% CI 1.09, 1.68). Higher levels of TNT-I were associated with the burden of carotid atherosclerosis at baseline in unadjusted models (β 0.66, 95% CI 0.46, 0.87; Table 1) and after controlling for CV risk factors (adjusted β 0.27, 95% CI 0.08, 0.46; Table 1). However, baseline TNT-I levels did not predict carotid atherosclerosis progression (p=0.47). No significant association was found between baseline levels of NT-proBNP and carotid atherosclerosis at baseline (adjusted P=0.15) or the rate of atherosclerosis progression (adjusted p=0.64). No interaction was found between each of the biomarkers and sex.

Conclusion: Higher TNT-I is associated with more pronounced atherosclerosis in patients with PsD independently of usual CVD risk factors. The utility of hsTnI in improving CV risk stratification in these PsD patients warrants assessment.

*Table 1 – The Association between Troponin I levels and Total Plaque Area at Baseline by Linear Regression Model in Patients with Psoriatic Disease (N=391)**
Variable	Adjusted β	95% Confidence Interval	P value
High-Sensitivity Troponin I* (ng/L)	0.27	0.08, 0.46	0.006
Age (10 year increase)	0.06	0.05, 0.07	<0.001
Sex: Female	-0.18	-0.49, 0.12	0.25
BMI (kg/m²)	0.01	-0.01, 0.04	0.32
Hypertension (y/n)	0.22	-0.11, 0.56	0.18
Diabetes (y/n)	0.24	-0.30, 0.78	0.38
Smoking (Current vs. No)	0.46	0.04, 0.88	0.03
LDL-c (mmol/L)	0.27	0.12, 0.42	<0.001
HDL-c (mmol-L)	0.002	-0.37, 0.38	0.99
Use of lipid lowering drugs (y/n)	0.68	0.36, 1.01	<0.001
Creatinine (μmol/L)	0.21	-0.62, 1.05	0.61
*log transformed

Disclosure: L. Eder, None; V. Chandran, None; I. B. McInnes, None; R. J. Cook, None; D. D. Gladman, None; P. Welsh, None; N. Sattar, None; P. Harvey, None.

To cite this abstract in AMA style:

Eder L, Chandran V, McInnes IB, Cook RJ, Gladman DD, Welsh P, Sattar N, Harvey P. Cardiac Biomarkers and Carotid Atherosclerosis and Its Progression in Psoriatic Disease [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/cardiac-biomarkers-and-carotid-atherosclerosis-and-its-progression-in-psoriatic-disease/. Accessed November 11, 2019.

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