Disease activity and hyperuricemia predict the development of cardiovascular events in patients with Psoriatic Arthritis: results of the 10-year prospective evaluation in the CARMA cohort

Abstract

Objective: To identify predictors of cardiovascular (CV) events in psoriatic arthritis (PsA) patients from the CARdiovascular in RheuMAtology (CARMA) project during 10 years of prospective follow-up.

Methods: Between July 2010 and January 2012, 725 PsA patients were enrolled from 67 Spanish hospitals. Analyses focused on 682 patients without prior CV events at baseline. At 10-year follow-up, CV event occurrence, patient-years, and linearized event rates were evaluated. Cox regression analyses were performed, both crude and adjusted for the PREVENT-CVD score.

Results: Over 6397 patient-years, 85 patients (12.46%) experienced CV events, yielding a rate of 1.33 per 100 patient-years. Patients with CV events were older (67.1 ± 11.1 vs. 56.7 ± 11.8 years, p < 0.001), more often male (68.2% vs. 51.9%, p = 0.005), and had higher frequencies of hypertension (60.0% vs. 21.8%, p < 0.001), diabetes (18.8% vs. 6.0%, p = 0.001), and dyslipidemia (56.5% vs. 29.8%, p < 0.001). They also showed greater abdominal perimeter and body mass index (p < 0.05 for both). After adjusting for PREVENT-CVD, the highest tertile of DAS28-ESR remained a significant predictor of CV events (HR 1.79; 95%CI: 1.03-3.14; p = 0.04). Urate in the highest tertile was also independently associated in the crude model (HR 1.88; 95%CI: 1.11-3.20; p = 0.02). When stratified (<6.5, 6.5-8.9, and ≥9.0 mg/dl), urate≥9.0 mg/dl was also associated with increased risk of CV events in the adjusted model (HR 3.50; 95%CI: 1.10-11.2; p = 0.02). While HAQ score in the third tertile was associated with increased CV risk in the crude analysis (HR 1.70; p = 0.04), this association did not persist after adjustment.

Conclusions: Disease activity and elevated urate levels independently predict CV events in PsA, highlighting their value as markers of CV risk beyond traditional factors captured by the PREVENT-CVD score.

Keywords: Cardiovascular risk; DAS28-ESR; Disease activity; PREVENT; Psoriatic arthritis; Urate.