Psoriatic Arthritis: Independent Risk Factor for Cardiovascular Disease

Psoriatic arthritis (PsA) is an independent risk factor for cardiovascular disease, according to a new meta-analysis.

The analysis, published April 25 in the journal Arthritis Care & Research, found a 43 percent increase in the risk of cardiovascular disease for patients with psoriatic arthritis compared with the general population. The risk of incident cardiovascular events was increased by 55 percent.

"These findings support the notion that PsA is an independent risk factor for cardiovascular diseases," wrote University of Toronto clinical and research fellow Ari Polachek, M.D., and colleagues.

The researchers conducted a systematic review and identified 11 studies that compared  cardiovascular outcomes in patients with psoriatic arthritis to the general population. Six of the studies were cross-sectional, and five were cohort studies. Altogether, nearly 33,000 psoriatic arthritis patients were included.  [[{"type":"media","view_mode":"media_crop","fid":"48884","attributes":{"alt":"©SebastianKaulitzki/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_6458044992665","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5870","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©SebastianKaulitzki/Shutterstock.com","typeof":"foaf:Image"}}]]

Overall cardiovascular disease and incidents of cardiac events were increased in the patient group, the researchers found. In addition, there was a 68 percent increase in myocardial infarction risk in psoriatic arthritis patients, according to the six studies that included that outcome. Eight studies examined cerebrovascular events and found a 22 percent increased risk. Congestive heart failure was recorded in four studies and showed a 31 percent increase in risk in psoriatic arthritis.

The magnitude of the risk appeared similar to the magnitudes found in patients with severe psoriasis, the researchers reported. Previous studies have found approximately a 40 percent increased risk of cardiovascular disease in psoriasis, but psoriatic arthritis had not been examined as closely. However, some studies on psoriatic arthritis do point to the mechanism for the increased cardiovascular risk, Polachek and his colleagues wrote. Psoriatic arthritis patients show abnormalities in arterial wall stiffness and endothelial function in the vessels, for example. Levels of inflammation in psoriatic arthritis have also been linked to the development of plaques.

The study illustrates the limits of relying on risk algorithms designed for the general population when dealing with psoriatic arthritis patients, the researchers wrote. Still, "aggressive primary cardiovascular risk prevention should be part of standard of care in patients with PsA," researchers wrote.

Odds ratios for cardiovascular risk in psoriatic arthritis patients versus the general population:

(All confidence intervals 95 percent)

References:

Polachek A, Touma Z, Anderson M, Eder L. “Risk of cardiovascular morbidity in patients with psoriatic arthritis: A meta-analysis of observational studies.” Arthritis Care & Research 2016. DOI: 10.1002/acr.22926