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Atherosclerotic plaque burden predicts CV events in PsD patients

12 Jul 2019

The burden of carotid atherosclerosis, as detected and quantified by ultrasound, in patients with psoriatic disease (PsD) independently predicts future incident cardiovascular (CV) events, according to a recent study. Hence, combining this vascular imaging data with clinical and laboratory measures of traditional CV risk factors could improve the accuracy of CV risk stratification in PsD.

Researchers examined a cohort of 559 PsD patients who underwent ultrasound evaluation of the carotid arteries at baseline to ascertain whether the addition of imaging data could improve CV risk prediction by the Framingham Risk Score (FRS).

A total of 23 patients developed CV events during a mean follow-up of 3.69 years. The events included 10 cases of myocardial infarction, five of stroke, 12 of revascularization, three of congestive heart failure exacerbation, seven of angina and one of transient ischaemic attack.

In the entire population, mean total plaque area (TPA) was 0.18 cm2 and mean carotid intima media thickness (cIMT) was 639 µm. Most patients had atherosclerotic plaques at baseline: 27 percent had unilateral plaques and 31.5 percent had bilateral plaques. Compared with patients who did not develop CV events, those who did had greater burden of traditional CV risk factors and atherosclerosis at baseline. 

The rate of developing a first CV event during the study period was 1.11 events per 100 patient years. In separate analyses, all variables used to measure the extent of atherosclerosis on ultrasound strongly predicted CV events despite controlling for FRS: TPA (hazard ratio (HR), 3.74, 95 percent CI, 1.55–8.85; p=0.003), mean cIMT (HR, 1.21, 1.03–1.42; p=0.02), max cIMT (HR, 1.11, 1.01–1.22; p=0.03) and high TPA category (HR, 3.25, 1.18–8.95; p=0.02).

These findings suggest that assessing the burden of atherosclerosis may provide a global estimation of the combined effect of traditional and disease-related factors on the vasculature system, which can potentially improve CV risk stratification in psoriatic patients beyond clinical risk algorithms that rely solely on traditional CV risk factors, the researchers said.

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