Underestimation of Risk of Carotid Subclinical Atherosclerosis by Cardiovascular Risk Scores in Patients with Psoriatic Arthritis

Shen, Jiayun; Lam, Shi; Shang, Qing; Wong, Chun‐Kwok; Li, Edmund K.; Wong, Priscilla; Kun, Emily W.; Cheng, Ikp; Li, Martin; Li, Tena K; Zhu, Tracy Y.; Lee, Jack Jock-Wai; Chang, Ming; Lee, Alex; Tam, Lai‐Shan

doi:10.3899/jrheum.170025

Cited by 27 publications

(18 citation statements)

References 49 publications

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“…Their study demonstrated suboptimal performances of established cardiovascular (CV) risk scores in identifying asymptomatic coronary artery disease as confirmed by coronary computed tomography angiography (CCTA) among patients with psoriatic arthritis (PsA). The results were in line with our study based on carotid subclinical atherosclerosis 2 . However, they found that a multiplication factor of 1.5 accurately categorizes PsA patients as having a high risk of CV diseases, presumably based on the presence of coronary atherosclerosis.…”

supporting

confidence: 92%

Dr. Tam, et al, reply

2018

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supporting

confidence: 92%

Dr. Tam, et al, reply

2018

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“…Similar to psoriasis, PsA is associated with increased prevalence of traditional cardiovascular risk factors, greater subclinical CVD assessed as vascular inflammation (VI) by 18-FDG PET/CT and ultrasound-guided carotid plaque assessment and intima-media thickness measurement, and elevated rates of major adverse cardiovascular events (MACEs) ( 34 – 38 ). Furthermore, like psoriasis, traditional risk factors do not fully capture the risk of CVD in PsA ( 39 , 40 ).…”

Section: Chronic Inflammation and Cardiovascular Co-morbiditiesmentioning

confidence: 99%

Potential Immunological Links Between Psoriasis and Cardiovascular Disease

Sajja¹,

Joshi²,

Teague³

et al. 2018

Front. Immunol.

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Preclinical and clinical research provide strong evidence that chronic, systemic inflammation plays a key role in development and progression of atherosclerosis. Indeed, chronic inflammatory diseases, such as psoriasis, are associated with accelerated atherosclerosis and increased risk of cardiovascular events. Contemporary research has demonstrated plausible mechanistic links between immune cell dysfunction and cardiometabolic disease in psoriasis. In this review, we describe the role of potential common immunological mechanisms underlying both psoriasis and atherogenesis. We primarily discuss innate and adaptive immune cell subsets and their contributions to psoriatic disease and cardiovascular morbidity. Emerging efforts should focus on understanding the interplay among immune cells, adipose tissue, and various biomarkers of immune dysfunction to provide direction for future targeted therapy.

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“…Therefore, these algorithms fail to identify a large part of high-risk patients in the RA population [ 43 , 44 ]. Also in systemic lupus erythematosus (SLE) and psoriatic arthritis (PsA) patients, recent studies showed underperformance of SCORE and QRISK3 in identifying vascular ultrasound-based high CVD risk [ 45 , 46 ]. This underperformance may also apply to the preclinical RA population.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular risk in persons at risk of developing rheumatoid arthritis

et al. 2020

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Background Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group. Methods In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline. Results Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls. Conclusion Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.

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Underestimation of Risk of Carotid Subclinical Atherosclerosis by Cardiovascular Risk Scores in Patients with Psoriatic Arthritis

Abstract: All CV risk scores underestimated the SCA+ risk. EULAR-recommended modification improved the sensitivity of FRS and ASCVD only to a moderate level.

Cited by 27 publications

References 49 publications

Dr. Tam, et al, reply

Dr. Tam, et al, reply

Potential Immunological Links Between Psoriasis and Cardiovascular Disease

Cardiovascular risk in persons at risk of developing rheumatoid arthritis

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