Session Type: Abstract Submissions (ACR)
Background/Purpose: Patients diagnosed with rheumatoid arthritis and psoriatic arthritis (PsA) have an increased risk of multiple comorbidities that predispose them to cardiovascular disease (CVD). Although it has been documented that the Framingham Risk Score (FRS) underestimates the 10-year risk of CVD in patients with rheumatoid arthritis, the predictive accuracy of the FRS has not been evaluated in PsA.
Methods: The study population comprised a population-based inception cohort of patients with PsA who fulfilled the ClASsification of Psoriatic ARthritis (CASPAR) criteria between 1989 and 2008. Data on CVD risk factors and all CVD events (myocardial infarction, CV death, angina, revascularization procedures, heart failure, stroke and intermittent claudication) were collected via medical record review. For each patient, the 10 year FRS (Circulation 2008;117;743-753) was calculated at time of PsA diagnosis. Poisson regression models were used to obtain the standardized incidence ratio (SIR), which is the ratio of observed CVD in PsA to predicted CVD obtained from the FRS.
Results: Among 150 incident PsA patients without a history of CVD, 32 patients experienced a CVD event during a mean follow-up of 11.6 years corresponding to an absolute risk of 17.4 per 1000 person years. Of 126 patients who were ≥30 years of age and without a history of CVD at time of PsA diagnosis, the mean FRS was 9.7%. Accounting for length of follow-up, this translated to 10 predicted events. However, 18 patients experienced a CVD event in the first 10 years, corresponding to a 10 year cumulative incidence of 17% (95 % confidence interval [CI]: 10-24%). This was almost twice as high as predicted by the FRS (SIR: 1.80; 95% CI: 1.14-2.86; p=0.012). This two-fold increased CVD risk was consistent across age groups.
Conclusion: We observed a higher than expected incidence of CVD events within our inception cohort of patients with PsA, with an actual risk of about twice that predicted by the FRS. This increased risk underscores the need for close cardiovascular follow-up in this population.
F. C. Ernste,
C. S. Crowson,
E. L. Matteson,
H. Maradit Kremers,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-cardiovascular-risk-in-patients-recently-diagnosed-with-psoriatic-arthritis-a-population-based-cohort-study/