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Cardiac and cardiovascular morbidities in patients with psoriatic arthritis: a population-based case control study

  • Adi Kibari
  • Arnon D. Cohen
  • Tal Gazitt
  • Haim Bitterman
  • Idit Lavi
  • Ilan Feldhamer
  • Guy Shalom
  • Sari Greenberg-Dotan
  • Devy ZismanEmail author
Original Article

Abstract

Objective

To assess the prevalence of risk factors associated with cardiovascular disease (CVD) and CVD-related morbidity in a large Middle-Eastern psoriatic arthritis (PsA) cohort.

Method

A retrospective case control study was conducted using Israel’s largest health care provider’s patient database from 2000 to 2013. For each patient with PsA, 10 patients with no history of psoriasis or arthritis were matched for age and sex. Analysis of CVD-related risk factors and morbidity included hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus type 2 (DM-2), obesity, smoking, ischemic heart disease (IHD), congestive heart failure (CHF), cerebrovascular accident (CVA), carotid artery disease, peripheral vascular disease (PVD), aortic aneurism, valvular heart disease (VHD), and cardiomyopathy. Statistical analysis was conducted using t test and chi-square tests as appropriate. Univariate and multivariable logistic regression models assessed the association between PsA and CVD-related risk factors and morbidity.

Results

Three thousand one hundred sixty-one PsA patients were included, with average age 58 ± 15.0 years, of whom 53.4% were women. Increased prevalence of DM-2, HLD, HTN, and obesity (OR 1.7, 1.5, 1.5, 1.5 respectively) was noted in the PsA group. Increased prevalence of IHD (p < 0.0001), PVD (p < 0.0001), CHF (p = 0.002), VHD (p < 0.0001), and cardiomyopathy (p = 0.006) was found in the PsA group compared to the control group even after adjusting for CVD risk factors.

Conclusions

A high prevalence of CVD-related risk factors and morbidity was found in this Middle Eastern PsA population, in accordance with data from other geographic regions. These results emphasize the importance of clinician awareness of the increased risk for CVD-related complications in PsA patients.

Keywords

Cardiovascular disease (CVD) risk factors CVD-related morbidity Psoriatic arthritis (PsA) 

Notes

Compliance with ethical standards

Consent

The study was carried out in compliance with the Helsinki Declaration. Internal Review Board approval was obtained from the Ethics Committee of Carmel Medical Center. Requirement for individual patient consent forms was waived due to the retrospective, observational nature of the study.

Disclosures

None.

References

  1. 1.
    Husni ME, Mease PJ (2010) Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep 12:281–287CrossRefGoogle Scholar
  2. 2.
    Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, Jullien D, Aractingi S, Aubin F, Joly P, le Maître M, Ortonne JP, Paul C, Richard MA (2013) Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 27:12–29CrossRefGoogle Scholar
  3. 3.
    Russolillo A, Iervolino S, Peluso R, Lupoli R, di Minno A, Pappone N, di Minno MND (2013) Obesity and psoriatic arthritis: from pathogenesis to clinical outcome and management. Rheumatol 52:62–67CrossRefGoogle Scholar
  4. 4.
    Tam LS, Tomlinson B, Chu TW et al (2008) Cardiovascular risk profile of patients with psoriatic arthritis compared to controls—the role of inflammation. Rheumatol 47:718–723CrossRefGoogle Scholar
  5. 5.
    Jamnitski A, Symmons D, Peters MJ et al (2013) Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review. Ann Rheum Dis 72:211–216CrossRefGoogle Scholar
  6. 6.
    Han C, Robinson DW, Hackett MV et al (2006) Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol 33:2167–2172Google Scholar
  7. 7.
    Gladman DD, Ang M, Su L, Tom BD et al (2009) Cardiovascular morbidity in psoriatic arthritis. Ann Rheum Dis 68:1131–1135CrossRefGoogle Scholar
  8. 8.
    Rennert G, Peterburg Y (2001) Prevalence of selected chronic diseases in Israel. Isr Med Assoc J 3:404–408Google Scholar
  9. 9.
    Zisman D, Bitterman H, Shalom G, Feldhamer I, Comanesther D, Batat E, Greenberg-Dotan S, Cohen S, Cohen AD (2016) Psoriatic arthritis treatment and the risk of herpes zoster. Ann Rheum Dis 75:131–135CrossRefGoogle Scholar
  10. 10.
    Dreiher J, Kresch FS, Comaneshter D, Cohen AD (2012) Risk of Herpes zoster in patients with psoriasis treated with biologic drugs. J Eur Acad Dermatol Venereol 26:1127–1132CrossRefGoogle Scholar
  11. 11.
    Cohen AD, Weitzman D, Birkenfeld S, Dreiher J (2010) Psoriasis associated with hepatitis C but not with hepatitis B. Dermatol 220:218–222CrossRefGoogle Scholar
  12. 12.
    Kimhi O, Caspi D, Bornstein NM, Maharshak N, Gur A, Arbel Y, Comaneshter D, Paran D, Wigler I, Levartovsky D, Berliner S (2007) Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin Arthritis Rheum 36:203–209CrossRefGoogle Scholar
  13. 13.
    Mok CC, Ko GTC, Ho LY, Yu KL, Chan PT, To CH (2011) Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis. Arthritis Care Res 63:195–202CrossRefGoogle Scholar
  14. 14.
    Khraishi M, Aslanov R, Rampakakis E, Pollock C, Sampalis JS (2014) Prevalence of cardiovascular risk factors in patients with psoriatic arthritis. Clin Rheumatol 33:1495–1500CrossRefGoogle Scholar
  15. 15.
    Gulati AM, Semb AG, Rollefstad S, Romundstad PR, Kavanaugh A, Gulati S, Haugeberg G, Hoff M (2016) On the HUNT for cardiovascular risk factors and disease in patients with psoriatic arthritis: population-based data from the Nord-Trøndelag Health Study. Ann Rheum Dis 75:819–824CrossRefGoogle Scholar
  16. 16.
    Johnsson H, McInnes IB, Sattar N (2012) Cardiovascular and metabolic risks in psoriasis and psoriatic arthritis: pragmatic clinical management based on available evidence. Ann Rheum Dis 71:480–483.  https://doi.org/10.1136/annrheumdis-2011-200567 CrossRefGoogle Scholar
  17. 17.
    Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT (2004) Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 34:585–592CrossRefGoogle Scholar
  18. 18.
    Cognitive impairment in patients with psoriasis: a matched case-control study. Innamorati M1, Quinto RM2, Lester D3, Iani L2, Graceffa D4, Bonifati C4Google Scholar
  19. 19.
    Korkoliakou P, Christodoulou C, Kouris A et al (2014) Alexithymia, anxiety and depression in patients with psoriasis: a case–control study. Ann General Psychiatry 13:1CrossRefGoogle Scholar
  20. 20.
    Gezer O, Batmaz İ, Sariyildiz MA et al (2014) Sleep quality in patients with psoriatic arthritis. Int J Rheum Dis.  https://doi.org/10.1111/1756-185X.1250
  21. 21.
    Reich A, Welz-Kubiak K, Rams L (2014) Apprehension of the disease by patients suffering from psoriasis. Postep Derm Alergol 31:289–293Google Scholar
  22. 22.
    Vogelzangs N, Seldenrijk A, Beekman AT et al (2010) Cardiovascular disease in persons with depressive and anxiety disorders. J Affect Disord 125:241–248CrossRefGoogle Scholar
  23. 23.
    Shapiro J, Cohen AD, Weitzman D, Tal R, David M (2012) Psoriasis and cardiovascular risk factors: a case-control study on inpatients comparing psoriasis to dermatitis. J Am Acad Dermatol 66:252–258CrossRefGoogle Scholar
  24. 24.
    Cohen AD, Gilutz H, Henkin Y, Zahger D, Shapiro J, Bonneh DY, Vardy DA (2007) Psoriasis and the metabolic syndrome. Acta Derm Venereol 87:506–509CrossRefGoogle Scholar
  25. 25.
    Rodriguez-Zúñiga MJM, Garcia-Perdomo HA (2017) J Am Acad Dermatol 77:657–666.e8CrossRefGoogle Scholar
  26. 26.
    Svedbom A, Dalén J, Mamolo C et al (2015) Increased cause-specific mortality in patients with mild and severe psoriasis: a population-based Swedish register. Acta Derm Venereol 95(7):809–815Google Scholar
  27. 27.
    Maisch B, Richter A, Sandmöller A, Portig I, Pankuweit S, for the members of project 9a in the BMBF-Heart Failure Network (2005) Inflammatory dilated cardiomyopathy (DCMI). Herz. 30(6):535–544CrossRefGoogle Scholar
  28. 28.
    Biyik I, Narin A, Bozok MA, Ergene O (2006) Echocardiographic and clinical abnormalities in patients with psoriasis. J Int Med Res 34(6):632–639CrossRefGoogle Scholar
  29. 29.
    Ramonda R, Lo Nigro A, Modesti V, Nalotto L, Musacchio E, Iaccarino L, Punzi L, Doria A (2011) Atherosclerosis in psoriatic arthritis. Autoimmun Rev 10(12):773–778CrossRefGoogle Scholar
  30. 30.
    Yim KM, Armstrong AW (2016) Updates on cardiovascular comorbidities associated with psoriatic diseases: epidemiology and mechanisms. Rheumatol Int 37:97–105.  https://doi.org/10.1007/s00296-016-3487-2 CrossRefGoogle Scholar
  31. 31.
    Boehncke WH, Boehncke S (2012) Cardiovascular mortality in psoriasis and psoriatic arthritis: epidemiology, pathomechanisms, therapeutic implications, and perspectives. Curr Rheumatol Rep 14:343–348CrossRefGoogle Scholar
  32. 32.
    Atzeni F, Turiel M, Boccassini L et al (2011) Cardiovascular involvement in psoriatic arthritis. Reumatismo 63:148–154CrossRefGoogle Scholar
  33. 33.
    Eder L, Zisman D, Barzilai M, Laor A, Rahat M, Rozenbaum M, Bitterman H, Feld J, Rimar D, Rosner I (2008) Subclinical atherosclerosis in psoriatic arthritis: a case-control study. J Rheumatol 35:877–882Google Scholar
  34. 34.
    Eder L, Chandran V, Gladman DD (2013) The Framingham Risk Score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease. Ann Rheum Dis 73:1990–1996CrossRefGoogle Scholar
  35. 35.
    Ramonda R, Puato M, Punzi L, Rattazzi M, Zanon M, Balbi G, Ortolan A, Frallonardo P, Faggin E, Plebani M, Zaninotto M, Lorenzin M, Pauletto P, Doria A (2014) Atherosclerosis progression in psoriatic arthritis patients despite the treatment with tumor necrosis factor-alpha blockers: a two-year prospective observational study. Joint Bone Spine 81(5):421–425CrossRefGoogle Scholar
  36. 36.
    Kristensen SL, McInnes IB, Sattar N (2015) Psoriasis, psoriatic arthritis and cardiovascular risk: are we closer to a clinical recommendation? Ann Rheum Dis 74:321–322CrossRefGoogle Scholar
  37. 37.
    Ernste FC, Sánchez-Menéndez M, Wilton KM, Crowson CS, Matteson EL, Maradit Kremers H (2015) Cardiovascular risk profile at the onset of psoriatic arthritis: a population-based cohort study. Arthritis Care Res 67:1015–1021CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Rheumatology UnitCarmel Medical CenterHaifaIsrael
  2. 2.Chief Physician’s Office, Central HeadquartersClalit Health ServicesTel AvivIsrael
  3. 3.Siaal Research Center for Family Medicine and Primary Care, Faculty of Health SciencesBen-Gurion University of the NegevBeershebaIsrael
  4. 4.The Ruth and Bruce Rappaport Faculty of Medicine, TechnionHaifaIsrael
  5. 5.Department of Community Medicine and EpidemiologyCarmel Medical CenterHaifaIsrael

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