Uncontrolled cardiometabolic risk factors and risk of cardiac dysfunction in psoriasis: the PSOCADIA study

Background and purpose Psoriasis is associated with cardiometabolic risk factors and cardiovascular disease. The purpose of this study was to assess the prevalence and control of cardiometabolic risk factors and their association with cardiac abnormalities as determined by transthoracic echocardiography (TTE) in psoriasis. Methods A total of 1.010 adults with psoriasis were prospectively included and underwent TTE. Participants were stratified according to the number of uncontrolled cardiometabolic risk factors and the presence of atherosclerotic cardiovascular disease (ASCVD), using individuals with controlled risk factors or without risk factors as the reference group. We applied the following cut-off values for uncontrolled cardiometabolic risk factors: blood pressure >140/90 mmHg, LDL-cholesterol >3 mmol/L, HDL-cholesterol <1.0 mmol/L for women and <0.9 mmol/L for men, triglycerides >1.7 mmol/L, and HbA1c >48 mmol/L. Clinical characteristics and echocardiographic parameters were compared between groups. Diastolic dysfunction (DDF) was defined according to ASE guidelines. Abnormal left ventricular ejection fraction (LVEF) was defined as <50% and abnormal global longitudinal strain (GLS) was defined as <16%. Cardiac structural damage (CSD) was defined as increased LV relative wall thickness, hypertrophy, and/or dilated left atrium. Results In the study population, 45.3% were women, median age was 54 years, the majority had moderate-to-severe psoriasis (72.7%), and most were treated with biologics (43.8%) or methotrexate (22.5%) (Table 1). Individuals with psoriasis had a high prevalence of cardiometabolic risk factors (Figure 1). Individuals with 1 or ≥2 uncontrolled cardiometabolic risk factors exhibited significant alterations of cardiac structure and function compared with the reference group, including higher E/e’ and decreased e’ (both p<0.001), indicating worse diastolic function (Table 1). LVEF was lower in those with ≥2 uncontrolled cardiometabolic risk factors, while those with 1 and ≥2 uncontrolled cardiometabolic risk factors had lower GLS compared with the reference group (19.4% and 18.6% vs. 20.4%, respectively; p<0.001). Having 1 or more uncontrolled cardiometabolic risk factors was associated with increased odds of DDF (OR 1.51, 95% CI: 1.05-2.18, p=0.028) and abnormal GLS (OR 1.91, 95% CI: 1.20-3.04, p=0.007), whereas ≥2 uncontrolled cardiometabolic risk factors were associated with higher odds of both DDF, abnormal LVEF, abnormal GLS, and CSD after adjustment for age and sex (Figure 1). ASCVD was associated with the highest odds of DDF, CSD, LVEF <50%, and GLS <16%. Conclusion Adults with psoriasis exhibited a high prevalence of uncontrolled cardiometabolic risk factors, suggesting insufficient risk factor management in this high-risk population. Increasing burden of uncontrolled risk factors was associated with higher odds of CSD and worse cardiac function.