Session Type: Abstract Submissions (ACR)
The prevalence of cardiovascular (CV) morbidity is increased in patients with psoriatic arthritis (PsA). CV risk is only partially explained by traditional CV risk factors. We aimed to identify predictors for CV events in a cohort of patients with PsA.
A retrospective cohort analysis was conducted in patients attending a large PsA clinic from 1978 to 2013. Patients were assessed at 6-12 month intervals according to a standard protocol. The collected information included demographics, lifestyle habits, medical history and disease-related outcomes. The following factors were assessed as candidate predictors of CV events: traditional CV risk factors, measures of PsA disease activity and laboratory biomarkers of inflammation. The primary outcome was the time to the first major CV event that comprised myocardial infarction (MI), ischemic stroke, re-vascularization or CV death. The secondary outcome was the time to any first CV event that included major CV events, angina, transient ischemic accident (TIA) and congestive heart failure (CHF). Each event was confirmed by reviewing hospital records and death certificates. Cox proportional hazard model, with time-dependent explanatory variables and date of birth as the time of origin, was used to compute the multivariate relative risk (RR) for incident CV events adjusting for sex and duration of PsA.
The analysis included 1103 patients with PsA for a combined follow-up time of 10,751 person-years, during which 104 cardiovascular events occurred (57 MI, 9 stroke, 19 revascularization, 2 CV death, 10 angina, 1 TIA and 6 CHF). The mean follow-up period was 9.8±8.5 years. The mean age at the first visit was 44±12.9 years and 56.3% of the patients were males. The incidence rate of CV events did not change significantly across the three decades from 1978 to 2013 (p=0.65). The following variables were associated with a higher incidence rate of major CV events: diabetes (RR 2.7, p=0.002), hypertension (RR 1.93 p=0.003), high triglycerides (RR 1.95 p=0.005), high cholesterol (RR 1.58 p=0.05), erythrocyte sedimentation rate (ESR) (RR 1.36 p=0.009), leukocyte count (RR 2.19 p=0.007) and tender joint count (RR 1.34, p=0.01). The variables that were associated with a higher incidence rate of any CV event were: diabetes (RR 2.68 p=0.0007), hypertension (RR 1.99, p=0.0008), high triglycerides (RR 1.71 p=0.02), ESR (RR 1.3 p=0.02) and tender joint count (RR 1.34 p=0.007). Achieving a minimal disease activity state was associated with a lower incidence rate of major CV events (RR 0.56, p=0.009) and any CV event (RR 0.62, p=0.02). No association was found between the use of non-steroidal anti-inflammatory drugs, disease modifying anti rheumatic agents or TNFα blockers and CV events.
Cardiovascular morbidity in patients with PsA is explained by the combined effect of elevated inflammatory burden and traditional CV risk factors. The achievement of a minimal disease activity state may decrease CV risk in patients with PsA.
R. J. Cook,
D. D. Gladman,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-for-cardiovascular-events-in-patients-with-psoriatic-arthritis-a-cohort-study/