Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease

• Published in: Annals of the rheumatic diseases Vol. 76; no. 7; pp. 1237 - 1244
• Main Authors: Shen, Jiayun, Wong, Ka-Tak, Cheng, Isaac T, Shang, Qing, Li, Edmund K, Wong, Priscilla, Kun, Emily W, Law, Mei Yan, Yip, Ronald, Yim, Isaac, Ying, Shirley, Li, Martin, Li, Tena K, Wong, Chun-Kwok, Zhu, Tracy Y, Lee, Jack Jock-Wai, Chang, Mimi, Lee, Alex Pui-Wai, Tam, Lai-Shan
• Format: Journal Article
• Language: English
• Published: England Elsevier Limited 01.07.2017
• Subjects: Adult; Age; Angiography; Angioplasty; Arteriosclerosis; Arthritis; Arthritis, Psoriatic - epidemiology; Atherosclerosis; Calcification; Cardiovascular disease; Cholesterol; Chronic illnesses; Comorbidity; Computed Tomography Angiography; Coronary Angiography; Coronary artery; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary vessels; Diabetes; Diagnosis; Gender; Health risk assessment; Heart; Heart diseases; Humans; Hypertension; Inflammation; Medical imaging; Middle Aged; Multivariate Analysis; Pain; Plaque, Atherosclerotic - epidemiology; Plaques; Prevalence; Psoriasis; Psoriatic arthritis; Risk factors; Stenosis; Surgery; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; Cardiovascular Disease; Psoriatic Arthritis; Atherosclerosis
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/annrheumdis-2016-210390

ObjectivesTo evaluate coronary atherosclerosis in patients with psoriatic arthritis (PsA) and control subjects using coronary CT angiography (CCTA).MethodsNinety consecutive patients with PsA (male: 56(62.2%); 50.3±11.1 years) were recruited. 240 controls (male: 137(57.1%); 49.6±10.7 years) without known cardiovascular (CV) diseases who underwent CCTA due to chest pain and/or multiple CV risk factors were recruited for comparison.ResultsPatients with PsA and controls were matched in age, gender and traditional CV risk factors (all p>0.2). The prevalence of overall plaque (54(60%)/84(35%), p<0.001), calcified plaque (CP) (29(32%)/40(17%), p=0.002), mixed plaque (MP) (20(22%)/18(8%), p<0.001), non-calcified plaque (NCP) (39(43%)/53(22%), p<0.001) and combined MP/NCP (46(51%)/62(26%), p<0.001) were all significantly higher in patients with PsA. Three-vessel disease was diagnosed in 12(13%) patients with PsA and 7(3%) controls (p<0.001), while obstructive plaques (>50% stenosis) were observed in 8(9%) patients with PsA and 7(3%) controls (p=0.033). After adjusting for traditional CV risk factors, PsA remained an independent explanatory variable for all types of coronary plaques (OR: 2.730 to 4.064, all p<0.001). PsA was also an independent explanatory variable for three-vessel disease (OR: 10.798, p<0.001) and obstructive plaque (3.939, p=0.024). In patients with PsA, disease duration was the only disease-specific characteristic associated with more vulnerable plaques (MP/NCP) in multivariate analysis (1.063, p=0.031). The other independent explanatory variables were age ≥55 years (5.636, p=0.005) and male gender (8.197, p=0.001).ConclusionsPatients with PsA have increased prevalence, burden and severity of coronary atherosclerosis as documented by CCTA. Longer disease duration was independently associated with the presence of vulnerable MP/NCP plaques in patients with PsA.Trial registration number NCT02232321.