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06-06-2019 | Rheumatology | News | Article

Atherosclerotic plaque burden may aid CV risk prediction in psoriatic disease

medwireNews: Increased atherosclerotic plaque burden, as estimated by carotid ultrasound, is associated with an increased risk for cardiovascular events (CVE) in patients with psoriatic disease (PsD), Canadian researchers report.

They say: “Combining vascular imaging data with clinical and laboratory measures of traditional cardiovascular risk factors could improve accuracy of cardiovascular risk stratification in patients with PsD and facilitate earlier initiation of appropriate treatment to reduce CVE in this population.”

Among 559 patients with PsD who underwent ultrasound assessment of the carotid arteries at baseline, 23 had a CVE during a mean 3.7 years of follow-up, giving an overall incidence of 1.11 events per 100 patient–years.

These included 12 patients needing revascularization procedures, 10 patients with myocardial infarction (two fatal), seven patients with angina, five patients with stroke (one fatal), three patients with congestive heart failure exacerbation, and one patient with transient ischemic attack.

The majority of patients had either unilateral (27%) or bilateral (32%) plaques at baseline. The mean total plaque area (TPA) was 0.18 cm2 while mean carotid intima media thickness (cIMT) was 639 μm.

Multivariate analysis showed that, after adjustment for Framingham Risk Score (FRS), patients with a high TPA (≥0.21 cm2) were twice as likely to experience a CVE during follow-up as those with a low TPA (<0.21 cm2; hazard ratio=2.03).

In addition, each 100 µm increase in mean cIMT and maximal cIMT was associated with a 20% and 11% increased risk for CVE, respectively.

Lihi Eder (University of Toronto, Ontario) and colleagues also found that adding the imaging data to traditional risk factors improved the predictive ability of the FRS alone.

Specifically, the area under the receiver operating characteristic curve for predicating 5-year CVE risk was 0.81 for FRS alone and was a significantly higher 0.84 when adding either mean cIMT or maximal IMT to the model.

Speaking in a press statement, Eder said: “Ultrasound is widely used in rheumatology settings as a point of care to detect joint inflammation.

Our study suggests that ultrasound can also be used to identify patients that are at high cardiovascular risk who may be missed by the conventional methods such as the Framingham risk score.”

She added: “This will allow early intervention, such as initiation of lipid lowering therapy, which will ultimately lower the risk of developing cardiovascular events.”

The study findings are published in Arthritis & Rheumatology.

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Arthritis Rheumatol 2019; doi:10.1002/art.40925

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