Diabetes is a Predictor of Cardiovascular Events in Patients with Psoriatic Arthritis

A new study comparing psoriatic arthritis patients who do and do not develop cardiovascular disease suggests a strong connection between arthritis that’s polyarticular at onset and subsequent strokes and coronary events.

Researchers from Spain started with 17 psoriatic arthritis patients who suffered 25 cardiovascular events between 2010 and 2014 (10 strokes, 9 acute coronary events and 6 ischemic peripheral vascular events). They then matched those patients with 189 psoriatic arthritis patients who were free of such events over the study period and looked for factors that predicted an elevated risk of cardiovascular events.

Single variable analyses found a number of risk factors: pustular psoriasis (odds ratio [OR], 5.5; p=0.02), polyarticular onset (OR, 3.2; p=0.03), polyarthritis during follow-up (OR, 2.9; p=0.04), arthritis onset

after 40 years of age (OR, 3.7; p=0.02), high lipid levels (OR, 2.8; p=0.04), hypertension (OR, 6.4; p=0.0008), diabetes (OR, 12.1; p<0.0001) and lower educational level (OR, 3.2; p=0.05).

After controlling for age and other confounders, however, only 2 factors remained as independent predictors of cardiovascular risk: diabetes (OR, 8.1; p=0.001) and polyarticular onset of PsA (OR, 3.7; p=0.043).

“In this study we analyzed in detail those disease factors that may help in predicting cardiovascular disease development in psoriatic arthritis. Given that the prevalence of cardiovascular disease in psoriatic disease is high, the evaluation of cardiovascular risk should include not only those factors inherent to this risk in general, but also those additional traits related to the inflammatory nature of the disease that may suppose an additional risk beyond that attributable to classic cardiovascular risk factors,” the study authors wrote in Clinical and Experimental Rheumatology.

“Patients who developed major adverse cardiac events were those more severely affected by the disease. Indeed, they had one of the most severe phenotype of psoriasis (pustular variants) as well as the most severe form of arthritis (polyarthritis) when compared to non-cardiovascular cases. These findings represent the known association that exists between the inflammatory burden of psoriatic disease and accelerated atherosclerosis.”

The investigators noted several limitations in their work, including the relatively small number of patients who developed cardiovascular disease, the fact that all patients came from a single tertiary hospital and the failure of their final calculations to consider every known risk factor for cardiovascular disease (i.e. acute phase reactants).

Still, they wrote, the new study substantially refines what is known about the connection between inflammatory rheumatic diseases and cardiovascular risk.

Prior research had definitively established that psoriatic arthritis patients were more prone than the general population to cardiovascular risk factors such as hypertension, diabetes, obesity, and dyslipidemia. It had also established that these risk factors alone were not enough to explain the frequency of cardiovascular disease among patients with psoriatic arthritis.

The authors of the new study believe their work indicates a possible reason that psoriatic arthritis patients suffer so much cardiovascular disease and gives physicians practical information about which psoriatic arthritis patients face the highest risks.

“The cardiovascular risk assessment should be routinely done by any clinician treating patients with psoriatic disease. This includes not only evaluation and treatment of classic cardiovascular risk factors, but also assessment of the inflammatory burden of the disease, as well as other markers of atherogenesis (CRP, intima-media thickness, carotid plaque area),” they wrote. “However, the most adequate form to do this is not clearly established at present. In addition, classic cardiovascular risk scores underestimate the risk in these patients.”