Patients with psoriasis and psoriatic arthritis (PsA) face a greater risk of coronary calcification, and patients with psoriasis have a greater chance of severe calcification and cardiovascular events, according to a recent analysis.
Though psoriasis is most commonly associated with inflammation of the skin and nails, the immune-mediated disease has been linked with a number of risk factors for cardiovascular disease, and well as with coronary artery disease severity, cardiovascular events, and mortality, according to corresponding author Andreas B. Tinggaard, MD, of Gødstrup Hospital, in Denmark, and colleagues. PsA, which occurs in about 3 in 10 patients with psoriasis, has been linked with higher rates of cardiovascular events, but it is unclear whether PsA itself is an independent risk factor for coronary artery disease, cardiovascular events, and mortality.
While cardiovascular risk and psoriasis and PsA have been studied before, the authors noted that no such study has focused on a population of patients who have been referred for coronary computed tomography angiography (CTA), which the European Society of Cardiology recommends as the initial diagnostic test for patient suspected of having coronary artery disease. The imaging technology produced a coronary artery calcium score (CACS), which has been shown to be a valuable tool in predicting risk of cardiovascular events.
Tinggaard and colleagues therefore decided to use a large database of health records of Danish patients who underwent CTA testing to see if they could better understand the severity of coronary artery disease in patients with psoriasis and PsA, as well as the risk of cardiovascular events associated with each. Their findings were published in the Journal of Internal Medicine.
The investigators used a pool of 46,022 patients in the CTA registry and identified patients with psoriasis and PsA, as well as a reference group of patients without inflammatory diseases. A total of 1356 patients with psoriasis and 370 patients with PsA were identified within the data set.
Their analysis showed coronary calcification was higher in patients with both psoriasis and PsA, but only psoriasis was associated with increased risk of obstructive coronary artery disease. The investigators found the adjusted odds ratio (aOR) for a CACS score above 0 was 1.26 (1.10–1.46) for patients with psoriasis. The aOR for a CACS score equal to or greater than 400 was 1.25 (1.04–1.50), and the aOR for coronary artery disease was 1.14 (0.98–1.33). For patients with PsA, the aOR for a CACS score above 0 was 1.28 (1.00-1.64). The crude hazard ratio for the primary outcome of coronary calcification or coronary artery disease was 1.49 (1.21-1.85) for patients with psoriasis, and the adjusted hazard ratio was 1.14 (0.92-1.41).
A follow-up analysis showed patients with psoriasis were at a greater risk of the composite endpoint of death and cardiovascular events, though the authors said that increased risk appeared to be “mainly explained by an increased prevalence of traditional cardiovascular risk factors and was thus not significant in the adjusted analysis.”
The authors said their findings support the idea that psoriasis, at least, is associated with an increased risk of cardiovascular disease, though they added that those increased risks do not necessarily translate to higher mortality.
“In this symptom-driven cohort, it is possible that preventive treatment (preferably with statins and aspirin according to international recommendations), lifestyle changes and management of cardiovascular risk factors after CTA findings seem to level out the long-term risk of cardiovascular events and all-cause mortality when comparing psoriasis and PsA patients with the reference group,” they said.
Still, the findings show that, based on objective CTA testing, psoriasis should continue to be seen as a risk factor for coronary artery disease.
Tinggaard AB, Hjuler KF, Andersen IT, Winther S, Iversen L, Bøttcher M. Prevalence and severity of coronary artery disease linked to prognosis in psoriasis and psoriatic arthritis patients: a multi-centre cohort study. J Intern Med. Published online May 12, 2021. doi:10.1111/joim.13311