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Cardiovascular risk factors predicting cardiac events are different in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis

Cooksey, Roxanne, Brophy, Sinead, Kennedy, Jonathan, Gutierrez, Fabiola Fernandez, Pickles, Tim, Davies, Ruth, Piguet, Vincent and Choy, Ernest 2018. Cardiovascular risk factors predicting cardiac events are different in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis. Seminars in Arthritis and Rheumatism 10.1016/j.semarthrit.2018.03.005

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Abstract

Objectives Increased cardiovascular risk in rheumatoid arthritis (RA) is well established. Examining traditional cardiovascular risk factors alone underestimates cardiovascular risk in RA. Systematic inflammation, measured by erythrocyte sedimentation rate or C-reactive protein is also a major risk factor. However, the contribution of traditional cardiovascular risk factors (such as obesity and hyperlipidaemia) compared to inflammation is uncertain in psoriatic arthritis (PsA) and RA. We examine the incidence of major adverse cardiac events (MACE) among patients with RA, PsA psoriasis, and controls adjusting for risk factors, inflammation and disease modifying anti-rheumatic drug treatment, to better define cardiovascular risk. Methods Using the Secure Anonymised Information Linkage databank, comprising routinely collected Welsh health data from 1999 to 2013, the incidence and first occurrence of a MACE in individuals with RA (n = 8650), PsA (n = 2128) and psoriasis (n = 24,630) compared to controls (n = 11,87,706) was investigated. Results Traditional cardiovascular risk factors are higher in RA, PsA and psoriasis than controls. After adjusting for these factors, additional cardiovascular risk was only significantly increased in female RA patients (HR = 1.3; 95% CI: 1.0–1.7; p = 0.05) and psoriasis (HR = 1.2; 95% CI: 1.0–1.4; p = 0.02) but not statistically significant for PsA (HR = 1.5; 95% CI: 0.9–2.5; p = 0.13). ESR and CRP were increased in patients with RA but not in patients with psoriasis. Conclusion Additional increased cardiovascular risk was observed in female RA and psoriasis but not PsA. Systematic inflammation is higher in RA but not psoriasis, indicating that there are varying mediators of cardiovascular risk across these conditions.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Medicine
Publisher: Elsevier: 12 months
ISSN: 0049-0172
Date of First Compliant Deposit: 4 May 2018
Date of Acceptance: 17 March 2018
Last Modified: 30 Oct 2018 02:05
URI: http://orca.cf.ac.uk/id/eprint/111208

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