Patients with Psoriatic Arthritis at Much Greater Risk for Cardiovascular Disease

A meta-analysis of observational studies finds that psoriatic arthritis is associated with significant increases in cardiovascular and cerebrovascular morbidity.

Investigators, who published their work in Arthritis Care & Research, included 11 studies of 32,973 psoriatic arthritis patients and found that such patients faced a 43% greater risk of cardiovascular disease than the general public (95% confidence interval [CI] for pooled odds ratio [OR], 1.24 to 1.66).

They also faced 55% greater risk of cardiovascular events (95% CI, 1.22 to 1.96), a 68% greater risk of myocardial infarction (95% CI, 1.35 to 2.15), a 22% greater chance of cerebrovascular diseases (95% CI, 1.05 to 1.41) and a 31% greater chance of heart failure (95% CI, 1.11 to 1.55).

“Observational studies that met the following criteria were assessed by 2 researchers: 1) Psoriatic arthritis diagnosis; 2) Cardiovascular or cerebrovascular outcomes; 3) Comparison group of individuals without psoriasis and rheumatic diseases; 4) case-control, cross-sectional or cohort studies,” wrote the study authors, who calculated weighted and pooled summary estimates of the maximally adjusted effect size estimates for cardiovascular and cerebrovascular diseases using the random-effects model.

The investigators also tested for heterogeneity among the studies by using the I² statistic and noted that there was significant heterogeneity in all of the main analyses (P < 0.001). This heterogeneity had produced conflicting reports about the likely connection between psoriatic arthritis and cardiovascular risk and led the authors of the new study to pool and analyze the available data.

The authors noted several limitations in their work, but said their findings should convince doctors to begin viewing psoriatic arthritis as an independent risk factor for cardiovascular disease. They also wrote that their findings highlight the shortcomings or risk evaluation tools like the Framingham Risk Score, which do not consider chronic inflammatory conditions and thus underestimate the risk of cardiovascular disease in patients with such conditions.

“Aggressive primary cardiovascular risk prevention should be part of standard of care in patients with psoriatic arthritis,” they wrote.

There are, however, studies that have reached the opposite conclusion and at least 1 small study that suggests that different types of psoriatic arthritis may be associated with different levels of cardiovascular and cerebrovascular risk.

Researchers from Spain, who published their findings earlier this year in Clinical and Experimental Rheumatology, 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).