Patients with psoriatic arthritis (PsA) have high risk for cardiovascular disease, but according to researchers at the Allegheny Health Network, few patients went to preventive cardiology appointments upon referral or were treated with statins or antiplatelet medications for atherosclerosis.
The study, “The impact of identifying carotid plaque on addressing cardiovascular risk in psoriatic arthritis,” published in Arthritis Research and Therapy, also shows that patients with atherosclerotic plaque are not more likely to receive further evaluation or to witness changes in their treatment regimens that address their increased cardiovascular risk.
The risk for cardiovascular disease is elevated in PsA patients compared to the general population and associated with poor outcomes. Addressing cardiovascular disease risk in these patients is important to identify which patients are likely to benefit from therapy, but there is a lack of consensus guidelines in the U.S. to help clinicians determine the risk in PsA patients.
Michael Lucke and his colleagues used carotid ultrasound to identify the presence of carotid plaque, a clear indication of atherosclerosis, which is a known risk factor for cardiovascular disease.
In the general population, carotid ultrasound results have been incorporated in patients at intermediate risk for cardiovascular disease to further improve risk stratification, and studies have suggested that it can be used to improve medication, with beneficial impact on patients’ outcomes.
The researchers aimed not only to identify the frequency of carotid plaque in asymptomatic PsA patients measured with carotid ultrasound, but also to understand whether the demonstration of plaque in these patients impacted the management of traditional risk factors, such as lipid levels.
The study enrolled 87 PsA patients, 39 of whom were found to have carotid plaque. Results showed that patients who were older, had a history of hypertension, and had high triglyceride levels were all significantly more likely to exhibit carotid plaque in their ultrasound.
Although all patients were referred for preventive cardiology appointments, only nine (10 percent) completed at least one visit to a cardiologist. There were no differences among those with plaque compared to those without plaque.
The percentage of patients who were on disease-modifying drugs for rheumatoid diseases was higher than in other studies of atherosclerosis in PsA, but only 21 and 27 percent of those with plaque were given statins or antiplatelet therapy, respectively, both of which are used to reduce the risk for cardiovascular events.
“Despite demonstration of high cardiac risk by carotid plaque, implementation of preventive cardiovascular strategies in PsA patients remained poor,” the researchers wrote. “This study emphasizes the need for further consensus in establishing protocols for cardiovascular risk assessment in PsA.”