Cardiovascular Risk Profile at the Onset of Psoriatic Arthritis: A Population-Based Cohort Study

ObjectiveThe role of cardiovascular disease (CVD) risk factors in psoriatic arthritis (PsA) is poorly understood. We examined the prevalence of CVD risk factors at initial onset of PsA and compared the observed incidence of CVD events with that predicted by the Framingham Risk Score (FRS) to determine its applicability in this patient population. MethodsA population-based incidence cohort of 158 patients with PsA who fulfilled Classification of Psoriatic Arthritis criteria for PsA in 1989-2008 was assembled. Medical records were reviewed to ascertain CVD risk factors and CVD events. Future risk of CVD was estimated using the FRS algorithm. ResultsMean age was 43.4 years (range 19-74 years), 61% were men, and 44% were obese (body mass index 30 kg/m(2)). Fifty-four patients (34%) presented with 2 CVD risk factors at PsA incidence. Among 126 patients ages 30 years at PsA incidence with no prior history of CVD, 33% had an FRS 10%, with 11% having an FRS 20%, and 18 experienced a CVD event in the first 10 years of disease duration. The 10-year cumulative incidence of CVD events was 17% (95% confidence interval [95% CI] 10%-24%), almost twice as high as the predicted incidence based on the FRS (standardized incidence ratio 1.80, 95% CI 1.14-2.86; P=0.012). ConclusionThe majority of newly diagnosed PsA patients have a >10% risk of CVD within 10 years of PsA incidence. The CVD risk in these patients is higher than expected and underestimated by the FRS.