Psoriatic Arthritis Linked to Elevated Aortic Stiffness

Patients with psoriatic arthritis (PsA) exhibited increased aortic stiffness when compared with controls, according to findings from the largest carotid-femoral pulse wave velocity (cfPWV)/PsA cohort to date. The data, published in Rheumatology and Therapy, revealed disease duration was the most important independent predictor of elevated aortic stiffness, followed by traditional cardiovascular risk factors.¹

“Although cardiovascular disease is one of the most predominant comorbidities in patients with PsA, no sufficient data exist on precise methodologies for accurately measuring this risk,” wrote a team of investigators led by Konstantinos Triantafyllias, MD, PhD, chief consultant and deputy medical director at Acute Rheumatology Center Rhineland-Palatinate, in Germany. “cfPWV has consistently predicted cardiovascular risk in the general population; nonetheless, its application as a surrogate marker in PsA remains limited, with scarce publications addressing this topic.”

Arterial stiffness, a well-established cardiovascular surrogate marker, is strongly associated with atherosclerosis, an important cause of cardiovascular disease.²

To measure and assess the aortic stiffness of patients with PsA and controls, investigators analyzed the cfPWV values and the Systemic Coronary Risk Evaluation (SCORE) in addition to laboratory and clinical factors. SCORE is designed to assess a person’s total 10-year risk for a fatal cardiovascular event.

The differences in cfPWV between patients and healthy controls, as well as any associations of cfPWV with disease- and patient-related characteristics, were evaluated. Information collected included demographics, current medication, use of disease-modifying antirheumatic drugs (DMARDs), and any traditional cardiovascular risk factors, such as nicotine use, dyslipidemia, hypertension, and diabetes mellitus. Laboratory measurements included inflammation markers, high- and low-density lipoprotein, total cholesterol, differential blood counts, glomerular filtration rate (GFR), and rheumatoid factor (RF).

Ultimately, 150 patients with PsA were recruited from the PSOriatic Arthritis CARDiovascular Disease (PSOCARD) cohort along with 88 healthy controls. The median age in the PsA cohort was 55 years (47.0–63.0) and 61.3% were female. The median age in healthy controls was 51 years (36.5–58.0) and 82.5% were female.

Among patients with PsA, the cfPWV was significantly higher than controls (7.80 [6.87–9.32] m/s vs 6.76 [6.03–7.68] m/s, P <.001). This remained significant even after adjusting for confounders (0.457, 95% confidence interval [CI] .035–.879, Padj = .034). A multivariate analysis confirmed a statistically significant difference of cfPWV between the PsA group and controls (.646, 95% CI .230–1.062, Padj = .002).

The cfPWV was most notably independently associated with disease duration (r = .304, P = .001). Other factors included age (rho = .688, P <.001), systolic arterial pressure (rho = .351, P <.001), and glomerular filtration rate (inverse: rho = -.264, P = .001). cfPWV was also independently associated with red cell distribution width, which is a marker of major adverse cardiovascular events (MACE; rho = .190, P = .02).

In the control group cfPWV was strongly correlated with age (rho = 0.656, p < 0.001), and moderately correlated with body mass index (BMI; rho = .395, P = .001), mean arterial pressure (MAP; r = .429, P <.001), and SCORE (rho = .412, P <.001).

The SCORE demonstrated an increased cardiovascular risk in 8.73% of patients, although 16% exhibited cfPWV values of > 10 m/s, an indicator of end-organ disease and high cardiovascular risk.

Investigators noted limitations, including statistical differences in age, gender, and cardiovascular risk factors between cohorts.

“Since aortic stiffness can reflect the long-term effects of both traditional cardiovascular risk factors and inflammation-associated vascular damage in a non-invasive and radiation-free manner, cfPWV could prove to be a useful tool for the identification of patients with PsA with end-organ disease and thus high cardiovascular risk,” investigators concluded.

References

1. ^{Triantafyllias K, Liverakos S, Muthuraman M, Cavagna L, Parodis I, Schwarting A. Cardiovascular Risk Evaluation in Psoriatic Arthritis by Aortic Stiffness and the Systemic Coronary Risk Evaluation (SCORE): Results of the Prospective PSOCARD Cohort Study. Rheumatol Ther. Published online May 31, 2024. doi:10.1007/s40744-024-00676-z}
2. ^{Nabel EG, Braunwald E. A tale of coronary artery disease and myocardial infarction. N Engl J Med. 2012;366(1):54–63.}