Background/Purpose:

Cardiovascular disease risk is elevated in psoriatic arthritis (PsA) compared to the general population. Prior studies have demonstrated suboptimal evaluation and control of modifiable cardiovascular risk factors in patients with inflammatory arthritis by both Rheumatologists and Primary Care providers.  The presence of carotid plaque guides further risk stratification as it highly correlates with cardiovascular events.  It is unclear if the addition of carotid plaque screening in PsA would alter medical management.  This study investigates the value of screening asymptomatic PsA patients for carotid plaque on cardiovascular risk factor control. 

Methods:

86 patients with PsA from the COMPASS database  underwent carotid duplex ultrasound (CDU) and screened for the presence of plaque, which was defined using the Mannheim consensus criteria.  Referral to preventive cardiology was automatically generated through the electronic health record upon study enrollment for all patients.  Repeat US was performed at 12-24 months in 38 patients.  Demographics, cardiovascular risk factors, PsA history and disease activity, and medication use were recorded.  Fasting glucose, C-reactive protein, and lipid panels were assessed.  Our institution has identified a primary prevention consensus algorithm regarding a minimal low density lipoprotein (LDL) goal of 100 mg/dL, initiation of antiplatlet therapy, and lifestyle counseling, as appropriate, in patients with PsA whom are deemed as high risk for cardiovascular disease.

Results:

Carotid plaque was identified in 34 patients at baseline screening (39.5%).  Of patients with baseline plaque, 18 had a repeat ultrasound within 12-24 months time and all had persistent plaque.  Of patients without plaque at baseline, 15% (3/20) had new plaque formation on repeat ultrasound.  Mean LDL was 120 and 102 mg/dL , mean HDL was 55 and 55, and mean triglycerides were 203 and 96 in the  plaque and no plaque groups, respectively.  Overall, 33% (12/36) of patients with repeat screening had an LDL under 100 and 27% (10/36) were on antiplatelet medication.  Current statin use was 39% (7/18) by patients with plaque and none were on maximum doses.  Despite automatic referral, only 12% (11/86) of patients were seen by Preventive Cardiology, and 14 other patients were seen by a cardiologist for other reasons. 

Conclusion:

Despite noninvasive screening and automatic referrals in a high risk population, few PsA patients completed consultations with the Preventive Cardiology service.  Low utilization of preventive services was observed even in those patients with definitive evidence of atherosclerotic disease by identification of plaque. The percentage of patients with plaque is similar to other cohorts of PsA patients and is increased compared to the general population.  A minority of patients met stated LDL goals and few were on antiplatelet therapy.  Further characterization of lapses in the referral process is required to improve proactive modification of cardiovascular risk in PsA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-joint-effect-of-carotid-ultrasound-and-preventive-cardiology-referral-on-cardiovascular-risk-factor-modification-in-psoriatic-arthritis-patients/