Key result
Total plaque area on carotid ultrasound predicted incident cardiovascular events in patients with psoriatic disease (HR 3.74; 95% CI 1.55-8.85; P=0.003) when adjusted for the Framingham Risk Score.
Why the study?
To determine whether subclinical carotid atherosclerosis predicts incident cardiovascular events in patients with psoriatic disease and improves CV risk prediction beyond the Framingham Risk Score.
Does carotid ultrasound assessment predict incident cardiovascular events in patients with psoriatic disease?
Cohort (n=559)
Does carotid ultrasound assessment predict incident cardiovascular events in patients with psoriatic disease?
Carotid ultrasound measures of atherosclerosis, including total plaque area and intima-media thickness, independently predict incident cardiovascular events in patients with psoriatic disease beyond traditional risk factors.
May enhance CV risk stratification in PsD beyond FRS; leaves open need for prospective validation before practice change.
OBJECTIVE: This study aimed to assess whether subclinical atherosclerosis, as evaluated by carotid ultrasound, could predict incident cardiovascular events (CVEs) in patients with psoriatic disease (PsD) and determine whether incorporation of imaging data could improve CV risk prediction by the Framingham Risk Score (FRS). METHODS: In this cohort analysis, patients with PsD underwent ultrasound assessment of the carotid arteries at baseline. The extent of atherosclerosis was assessed using carotid intima-media thickness (CIMT) and total plaque area (TPA). Incident CVEs (new or recurrent) that occurred following the ultrasound assessment were identified. The association between measures of carotid atherosclerosis and the risk of developing an incident CVE was evaluated using Cox proportional hazards models, with adjustment for the FRS. RESULTS: In total, 559 patients with PsD were assessed, of whom 23 had incident CVEs ascertained. The calculated rate of developing a first CVE during the study period was 1.11 events per 100 patient-years (95% confidence interval [95% CI] 0.74-1.67). When analyzed separately in Cox proportional hazards models that were controlled for the FRS, the TPA (hazard ratio [HR] 3.74, 95% CI 1.55-8.85; P = 0.003), mean CIMT (HR 1.21, 95% CI 1.03-1.42; P = 0.02), maximal CIMT (HR 1.11, 95% CI 1.01-1.22; P = 0.03), and high TPA category (HR 3.25, 95% CI 1.18-8.95; P = 0.02) were each predictive of incident CVEs in patients with PsD. CONCLUSION: The burden of carotid atherosclerosis is associated with an increased risk of developing future CVEs. Combining vascular imaging data with information on traditional CV risk factors could improve the accuracy of CV risk stratification in patients with PsD.
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Sobchak et al. (2019) conducted a cohort in Psoriatic disease (n=559). Carotid atherosclerosis (total plaque area and carotid intima-media thickness) was evaluated on Incident cardiovascular events (CVEs) (HR 3.74, 95% CI 1.55-8.85, p=0.003). Total plaque area on carotid ultrasound predicted incident cardiovascular events in patients with psoriatic disease (HR 3.74; 95% CI 1.55-8.85; P=0.003) when adjusted for the Framingham Risk Score.
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