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 In particular, patients with so-called psoriatic arthritis may have
a three- to four-fold higher prevalence of plaque in their coronary
arteries, which leads to a higher heart attack risk.
Clinicians need to identify patients with high cardiovascular (CV)
risk so they can provide lifestyle advice and preventive treatment
to those individuals, said study author Lai-Shan Tam of the Chinese
University of Hong Kong.
Psoriasis and psoriatic arthritis are related, but not everyone who
has the red, scaly skin patches associated with psoriasis will
develop the more severe psoriatic arthritis associated with joint
swelling and pain.
According to the National Psoriasis Foundation, about 30 percent of
those with psoriasis develop the inflammatory arthritis, which that
can cause permanent damage to joints.
Compared to the general population, people with psoriatic arthritis
had a 68 percent higher risk of heart attack and a 43 percent higher
risk of death during previous studies, the authors of the new study
point out in the Annals of the Rheumatic Diseases. Although the
increased risk and association are known, studies can’t yet explain
why.
Atherosclerosis, or hardening and narrowing of the arteries, is one
risk factor that reliably predicts heart problems. Recent studies of
atherosclerosis in patients with psoriatic arthritis have been
limited to ultrasound images of the carotid arteries in the neck,
however, so Tam and colleagues decided to use CT scans to look at
multiple arteries around the heart.
The research team evaluated 90 psoriatic arthritis patients and 205
patients who didn’t have this condition but who did have
cardiovascular risk factors, such as chest pain.
The psoriatic arthritis patients, who didn’t have a prior heart
disease diagnosis, had significantly higher amounts of plaques of
all kinds, including non-calcified and mixed plaques that are
considered more likely to rupture and cause heart attacks.
Sixty percent of psoriatic arthritis patients had at least one
coronary plaque, as compared with 35 percent of the other patients.
In addition, the researchers found three-vessel disease in 13
percent of psoriatic arthritis patients, compared to 3 percent of
controls, and they found that blood vessels had narrowed by more
than 50 percent in 9 percent of patients with psoriatic arthritis,
versus 3 percent of controls.
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Men over age 55 with longer histories of psoriatic arthritis were
more likely to have the plaques most commonly associated with heart
problems.
If doctors know to look for signs of heart disease sooner, they may
be able to prescribe statins, anti-hypertension drugs and
anti-inflammatory drugs before needing more aggressive treatment
such as percutaneous coronary intervention or an angioplasty to
improve blood flow to the heart, Tam told Reuters Health by email.
This could also be true for patients with other chronic inflammatory
diseases such as rheumatoid arthritis, Tam and colleagues reported
in another study. The researchers would also like to study
atherosclerosis in patients with the milder psoriasis.
“A large proportion of patients could be having silent coronary
artery disease,” Tam said.
The study focuses on one group of patients at the Prince of Wales
Hospital in Hong Kong, and the results might not be applicable
everywhere, said Lihi Eder of the University of Toronto, who wasn’t
involved with the study. The researchers also couldn’t study the
effect of medications or changes for individual patients.
“The effect of psoriatic disease varies significantly over time,”
she told Reuters Health. But additional studies “investigating
atherosclerosis . . . could assist in understanding a link.”
SOURCE: http://bit.ly/2jfobMC Annals of the Rheumatic Diseases,
online January 5, 2017.
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
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