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Cardiovascular risk reclassification according to six cardiovascular risk algorithms and carotid ultrasound in psoriatic arthritis patients

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Abstract

The objective was to compare the prevalence of subclinical atherosclerosis and cardiovascular risk (CVR) reclassification using six CVR algorithms and a carotid ultrasound in psoriatic arthritis (PsA) patients and controls. The method was cross-sectional study. A total of 81 patients aged 40–75 years, who fulfilled the 2006 CASPAR criteria and 81 controls matched by age, gender, and comorbidities were recruited. CVR was evaluated according to six CVR algorithms, including Framingham Risk Score (FRS)-lipids, FRS-body mass index (BMI), Atherosclerotic Cardiovascular Disease (ASCVD) Algorithm, Systematic Coronary Risk Evaluation (SCORE), QRISK3, and Reynolds Risk Score (RRS). A carotid ultrasound was performed to identify the presence of carotid plaque (CP) defined as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing of the surrounding lumen ≥ 0.5mm. Patients with presence of CP, classified in the low-moderate risk by the CVR algorithms, were reclassified to a higher risk category. CP was more prevalent in PsA patients (44.4% vs 24.7%, p = 0.008), as was subclinical atherosclerosis (51.9% vs 33.3%, p = 0.017). When comparing the CVR reclassification to a higher risk category, a difference was found in the six CVR algorithms. The reclassification was more prevalent in PsA patients: 30.8% vs 12.3%, p = 0.004 with FRS-lipids; 28.4% vs 9.9%, p = 0.003 with FRS-BMI; 40.7% vs 19.8%, p = 0.003 with SCORE; 30.9% vs 16.0%, p = 0.026 with ASCVD algorithm; 37.0% vs 19.8%, p = 0.015 with RRS; and 33.3% vs 16.0%, p = 0.011 with QRISK3. The CVR algorithms underestimate the actual CVR of PsA patients. A carotid ultrasound should be considered as part of the CVR evaluation of PsA patients.

Key points

• Subclinical atherosclerosis was more prevalent in psoriatic arthritis patients than controls.

• Cardiovascular risk reclassification, through a carotid ultrasound, according to traditional cardiovascular risk algorithms was more common in psoriatic arthritis patients.

• The cardiovascular risk algorithm that showed the lowest reclassification rate in psoriatic arthritis patients was the FRS-BMI.

• All cardiovascular risk algorithms underestimate the actual risk of psoriatic arthritis patients, preventing the initiation of an adequate cardiovascular treatment.

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The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

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References

  1. Veale DJ, Fearon U (2018) The pathogenesis of psoriatic arthritis. Lancet 391(10136):2273–2284. https://doi.org/10.1016/S0140-6736(18)30830-4

    Article  CAS  PubMed  Google Scholar 

  2. Polachek A, Touma Z, Anderson M, Eder L (2017) Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies. Arthritis Care Res (Hoboken) 69(1):67–74. https://doi.org/10.1002/acr.22926

    Article  Google Scholar 

  3. Eder L, Thavaneswaran A, Chandran V, Cook R, Gladman DD (2015) Increased burden of inflammation over time is associated with the extent of atherosclerotic plaques in patients with psoriatic arthritis. Ann Rheum Dis 74(10):1830–1835. https://doi.org/10.1136/annrheumdis-2014-205267

    Article  CAS  PubMed  Google Scholar 

  4. Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Sodergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DP, Nurmohamed MT (2017) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76(1):17–28. https://doi.org/10.1136/annrheumdis-2016-209775

    Article  CAS  PubMed  Google Scholar 

  5. Martinez-Vidal MP, Andres M, Jovani V, Santos-Ramirez C, Romera C, Fernandez-Carballido C (2020) Role of carotid ultrasound and systematic coronary risk evaluation charts for the cardiovascular risk stratification of patients with psoriatic arthritis. J Rheumatol 47(5):682–689. https://doi.org/10.3899/jrheum.181223

    Article  PubMed  Google Scholar 

  6. Eder L, Chandran V, Gladman DD (2014) The Framingham Risk Score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease. Ann Rheum Dis 73(11):1990–1996. https://doi.org/10.1136/annrheumdis-2013-203433

    Article  PubMed  Google Scholar 

  7. Semb AG, Ikdahl E, Hisdal J, Olsen IC, Rollefstad S (2016) Exploring cardiovascular disease risk evaluation in patients with inflammatory joint diseases. Int J Cardiol 223:331–336. https://doi.org/10.1016/j.ijcard.2016.08.129

    Article  CAS  PubMed  Google Scholar 

  8. Polak JF, Szklo M, Kronmal RA, Burke GL, Shea S, Zavodni AE, O’Leary DH (2013) The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis. J Am Heart Assoc 2(2):e000087. https://doi.org/10.1161/JAHA.113.000087

    Article  PubMed  PubMed Central  Google Scholar 

  9. Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Garcia-Colunga JI, Arvizu-Rivera RI, Martinez-Moreno A, Villarreal-Perez JZ, Elizondo-Riojas G, Garza Elizondo MA (2016) Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis. Clin Rheumatol 35(11):2823–2827. https://doi.org/10.1007/s10067-016-3312-z

    Article  PubMed  Google Scholar 

  10. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, Group CS (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54(8):2665–2673. https://doi.org/10.1002/art.21972

    Article  PubMed  Google Scholar 

  11. Schoels MM, Aletaha D, Smolen JS (2015) Defining remission and treatment success using the DAPSA score: response to letter by Helliwell and Coates. Ann Rheum Dis 74(12):e67. https://doi.org/10.1136/annrheumdis-2015-208521

    Article  CAS  PubMed  Google Scholar 

  12. Langley RG, Ellis CN (2004) Evaluating psoriasis with Psoriasis Area and Severity Index, Psoriasis Global Assessment, and Lattice System Physician’s Global Assessment. J Am Acad Dermatol 51(4):563–569. https://doi.org/10.1016/j.jaad.2004.04.012

    Article  PubMed  Google Scholar 

  13. Rich P, Scher RK (2003) Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol 49(2):206–212. https://doi.org/10.1067/s0190-9622(03)00910-1

    Article  PubMed  Google Scholar 

  14. D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117(6):743–753. https://doi.org/10.1161/CIRCULATIONAHA.107.699579

    Article  PubMed  Google Scholar 

  15. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF, American College of Cardiology/American Heart Association Task Force on Practice G (2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129(25 Suppl 2):S49-73. https://doi.org/10.1161/01.cir.0000437741.48606.98

    Article  PubMed  Google Scholar 

  16. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetiere P, Jousilahti P, Keil U, Njolstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM, group Sp (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24(11):987–1003. https://doi.org/10.1016/s0195-668x(03)00114-3

    Article  CAS  PubMed  Google Scholar 

  17. Ridker PM, Buring JE, Rifai N, Cook NR (2007) Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA 297(6):611–619. https://doi.org/10.1001/jama.297.6.611

    Article  CAS  PubMed  Google Scholar 

  18. Hippisley-Cox J, Coupland C, Brindle P (2017) Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ 357:j2099. https://doi.org/10.1136/bmj.j2099

    Article  PubMed  PubMed Central  Google Scholar 

  19. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS, American Society of Echocardiography Carotid Intima-Media Thickness Task F (2008) Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 21(2):93–111. https://doi.org/10.1016/j.echo.2007.11.011 (quiz 189-190)

    Article  PubMed  Google Scholar 

  20. Ibanez-Bosch R, Restrepo-Velez J, Medina-Malone M, Garrido-Courel L, Paniagua-Zudaire I, Loza-Cortina E (2017) High prevalence of subclinical atherosclerosis in psoriatic arthritis patients: a study based on carotid ultrasound. Rheumatol Int 37(1):107–112. https://doi.org/10.1007/s00296-016-3617-x

    Article  CAS  PubMed  Google Scholar 

  21. Wah-Suarez MI, Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Arvizu-Rivera RI, Martinez-Moreno A, Ramos-Cazares RE, Abundis-Marquez EE, Guillen-Lozoya AH, Davila-Jimenez JA, Guillen-Gutierrez CY, Elizondo-Riojas G (2018) The best cardiovascular risk calculator to predict carotid plaques in rheumatoid arthritis patients. Clin Rheumatol 37(9):2373–2380. https://doi.org/10.1007/s10067-018-4181-4

    Article  PubMed  Google Scholar 

  22. Palmou-Fontana N, Martinez-Lopez D, Corrales A, Rueda-Gotor J, Genre F, Armesto S, Gonzalez-Lopez MA, Quevedo-Abeledo JC, Portilla-Gonzalez V, Blanco R, Hernandez JL, Llorca J, Gonzalez-Gay MA, Ferraz-Amaro I (2020) Disease activity influences cardiovascular risk reclassification based on carotid ultrasound in patients with psoriatic arthritis. J Rheumatol 47(9):1344–1353. https://doi.org/10.3899/jrheum.190729

    Article  CAS  PubMed  Google Scholar 

  23. Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Wah-Suarez M, Arvizu-Rivera RI, Martinez-Moreno A, Ramos-Cazares RE, Torres-Quintanilla FJ, Valdovinos-Banuelos A, Esquivel-Valerio JA, Garza-Elizondo MA (2017) Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis. Rheumatol Int 37(9):1507–1511. https://doi.org/10.1007/s00296-017-3769-3

    Article  PubMed  Google Scholar 

  24. Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, Davignon J, Erbel R, Fruchart JC, Tardif JC, Schoenhagen P, Crowe T, Cain V, Wolski K, Goormastic M, Tuzcu EM, Investigators A (2006) Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 295(13):1556–1565. https://doi.org/10.1001/jama.295.13.jpc60002

    Article  CAS  PubMed  Google Scholar 

  25. Armstrong AW, Brezinski EA, Follansbee MR, Armstrong EJ (2014) Effects of biologic agents and other disease-modifying antirheumatic drugs on cardiovascular outcomes in psoriasis and psoriatic arthritis: a systematic review. Curr Pharm Des 20(4):500–512. https://doi.org/10.2174/138161282004140213123505

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Sergio Lozano-Rodriguez, M.D., MWC, for his help in editing the manuscript. We also wish to thank Julieta Loya-Acosta, Alejandro Meza-Garza, Pablo Gutierrez-Gandara, Alejandra Perez-Villar, Itzel C. Zarate-Salinas, Mayra A. Reyes-Soto, Paola F. Frausto-Lerma, and Marielva Castro-Gonzalez for their help in the recruitment of our patients, and the health professionals that facilitate our work. Finally, many thanks to all participants that took part in the study and enabled this research to be possible.

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Authors and Affiliations

  1. Rheumatology Service, Internal Medicine Department, Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

    Dionicio A. Galarza-Delgado, Iris J. Colunga-Pedraza, Natalia Guajardo-Jauregui, Alejandra B. Rodriguez-Romero, Jesus A. Cardenas-de la Garza, Rosa I. Arvizu-Rivera, Diana E. Flores-Alvarado, Octavio Ilizaliturri-Guerra & Gisela Garcia-Arellano

  2. Cardiology Service, Internal Medicine Department, Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

    Jose R. Azpiri-Lopez & Salvador Lugo-Perez

  3. Radiology and Imaging Department, Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

    Andrea C. Garza-Acosta

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  1. Dionicio A. Galarza-Delgado
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Contributions

All the authors had access to the data and a role in writing the manuscript. Dionicio A. Galarza-Delgado, Jose R. Azpiri-Lopez, Iris J. Colunga-Pedraza, Natalia Guajardo-Jauregui, and Alejandra B. Rodriguez-Romero contributed to the study conception and design. Data collected by Natalia Guajardo-Jauregui, Alejandra B. Rodriguez-Romero, Salvador Lugo-Perez, and Andrea C. Garza-Acosta. Statistical analyses were performed by Natalia Guajardo-Jauregui, Alejandra B. Rodriguez-Romero, Jesus A. Cardenas-de la Garza, and Rosa I. Arvizu-Rivera. Analysis and interpretations were performed by Natalia Guajardo-Jauregui, Alejandra B. Rodriguez-Roemro, Salvador Lugo-Perez, Diana E. Flores-Alvarado, Octavio Ilizaliturri-Guerra, and Gisela-Garcia-Arellano. Writing of the first draft was performed by Natalia Guajardo-Jauregui, Alejandra B. Rodriguez-Romero, Salvador Lugo-Perez, and Jesus A. Cardenas-de la Garza. All the authors commented on posterior versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Jose R. Azpiri-Lopez.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Registration number of RE19-00001.

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All the data retrieved were anonymized. Written informed consent was obtained before the procedure.

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Galarza-Delgado, D.A., Azpiri-Lopez, J.R., Colunga-Pedraza, I.J. et al. Cardiovascular risk reclassification according to six cardiovascular risk algorithms and carotid ultrasound in psoriatic arthritis patients. Clin Rheumatol 41, 1413–1420 (2022). https://doi.org/10.1007/s10067-021-06002-0

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