Patients with Psoriatic Arthritis and Other Inflammatory Diseases Are at Higher Risk for Cardiovascular Events

The authors of “Risk of Major Cardiovascular Events in Patients with Psoriatic Arthritis, Psoriasis and Rheumatoid Arthritis: A Population-based Cohort Study,” published in Annals of the Rheumatic Diseases, examined the risk of myocardial infarction (MI), cerebrovascular accidents (CVA), CV death, and other major adverse cardiovascular events (MACE) among patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), or psoriasis and compared them to rates among healthy controls.

Using data from The Health Improvement Network (THIN) medical database in the UK, researchers identified 8706 patients with psoriatic arthritis, 41752 patients with rheumatoid arthritis, 138424 patients with psoriasis, and 82258 randomly selected unexposed patients.

They reported that patients with RA “were older and more often women.” Nearly half the patients with RA and PsA had been prescribed a DMARD, and 3% of patients with psoriasis had been prescribed a DMARD or received phototherapy. The researchers also found that “at least 65% of patients with PsA and RA had been prescribed NSAIDs compared with 24% with psoriasis and 47% of controls.”

Compared with the controls, “the prevalence of CV risk factors, MI, and stroke in the baseline period were elevated in patients with PsA, RA, and psoriasis.” Patients with PsA who had not been prescribed a DMARD, patients with RA, and patients with severe psoriasis had an increased risk of MACE.

Patients with PsA, patients with RA without a DMARD prescription, and patients with severe psoriasis also had a higher risk for myocardial infarction. Myocardial infarction risk “was substantially higher in patients with RA who had been prescribed a DMARD.”

The risk of incident stroke “was also significantly elevated in patients with PsA without a DMARD prescription (HR 1.33, 95% CI 1.03 to 1.71) which was similar to patients with RA and severe psoriasis.” Patients with RA and patients with severe psoriasis faced significantly elevated risk of CV death.

In their discussion of these results, the authors noted that “this is the first population-based study dedicated to examining MACE in PsA which may be an independent risk factor for major CV events including MI and stroke, although this was only statistically significant for patients who were not prescribed a DMARD.”

They also noted that this study is “the first longitudinal population-based study dedicated to the simultaneous examination of the incidence of MACE in PsA, psoriasis and RA after adjusting for traditional CV risk factors. All three diseases had statistically similar risks for the development of incident CV events after adjustment for age, sex, calendar year of cohort entry and traditional CV risk factors.”

Although the study has several strengths, including its large cohort and validated diagnoses and outcomes, the authors also identified several potential weaknesses, including a lack of disease activity measures, “generally absent biological medication records, possible missing DMARD prescriptions and the inability to account for over-the-counter NSAID use.”

They concluded this study provided good evidence for an increased incidence of MACEs in PsA, psoriasis, and RA. Because the hazard ratios for RA and psoriasis in this study were similar to risk estimates seen in previous studies, the authors wrote that it provided “internal validity for the study results in patients with PsA and external validity for the study as a whole.” These results “suggest the need for improved screening and management of traditional CV risk factors in patients with inflammatory diseases.”