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.

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.