Background/Purpose: Compared with cardiovascular (CV) risk in rheumatoid arthritis (RA), precise CV risk in psoriatic arthritis (PsA) and psoriasis is less established, particularly the relative contribution of traditional CV risk factors versus systemic inflammation. The objective of this study is to compare the incidence of Major Adverse Cardiac Events (MACE) among patients with RA, PsA and psoriasis with population controls adjusting for traditional CV risk factors, systemic inflammation, and Disease Modifying Anti-Rheumatic Drug s(DMARDs).

Methods: Using linked, routinely collected health data from 1999 to 2013 in Wales UK, available from the Secure Anonymised Information Linkage (SAIL) databank, which includes general practitioner, and hospital datasets, the incidence of a MACE was investigated in individuals with RA (n=8,650), PsA (n=2,128), psoriasis (n=24,630) and population controls (n= 1,187,706), while controlling for traditional CV risk factors, systemic inflammation (measured by erythrocyte sedimentation rate (ESR)), and DMARDs.

Results: Demographic details and incidence of MACE are listed in Table 1. After controlling for traditional risk factors, CV risk was significantly increased for individuals with RA (HR: 1.2, 95% CI: 1.0-1.3, p=0.038) and psoriasis (HR: 1.1, 95% CI: 1.0-1.3, p=0.025) but not for PsA (HR: 1.0, 95% CI: 0.7-1.5, p=0.887). ESR was significantly higher in patients with RA compared with patients with psoriasis, PsA and controls. ESR was associated with increased in CV risk in RA but not psoriasis or PsA. No interaction between DMARDs and MACE occurrence was observed. Table 1: Baseline Characteristics AND INCIDENCE OF MACE ControlRAPsAPsoriasis(n=1187706)(n=8650)(n=2128)(n=24630)Age at diagnosis (SD)50 (17.2)59.6 (14.6)50.3 (13.1)51.4 (16.2)Male49%32%47%49%Baseline BMI (SD)25.5 (5.1)26.8 (5.5)27.8 (5.9)26.5 (5.4)Hyperlipidemia7.30%13.90%12.60%11.40%Diabetes 7.80%14.10%13.10%11.90%Hypertension21.60%39.70%33.30%29.90%Smoker21.20%24.60%21.90%27.90%MACE Incidence rate per 1000PY (95% CI)4.5 (4.5 to 4.6)9.6 (8.8 to 10.5)2.9 (2.2 to 3.9)5.3 (5.0 to 5.7)

Conclusion: In addition to traditional CV risk factors, there is an increased incidence of CV disease for RA and psoriasis, but not for PsA. This demonstrates the varying mediators of CV risk across the conditions and highlights the need for different CV risk reduction strategies for specific diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-in-patients-with-psoriasis-psoriatic-and-rheumatoid-arthritis-a-prospective-study-using-secured-anonymised-information-technology-databank-in-wales-united-kingdom/