PsA patients may have hidden risk of heart disease

| Melissa Leavitt

According to a new study, psoriatic arthritis patients have an increased risk for cardiovascular disease—but that risk might not show up when doctors check for the usual signs of heart problems.

A diagnostic tool called the Framingham Risk Score (FRS) is one way doctors determine your risk for heart disease. It monitors things like blood pressure and cholesterol level to measure your risk of developing cardiovascular disease in the next 10 years. 

In a study published in July in Arthritis Care and Research, researchers determined the FRS for a group of newly diagnosed psoriatic arthritis patients, and compared that to the actual rate of cardiovascular disease that developed in these patients. About 125 patients were included in the study, and the average age of participants was 43. Researchers determined the FRS of the group, and tracked actual cardiovascular outcomes, by analyzing patients’ medical records.

The actual rate of cardiovascular disease was nearly double what the FRS predicted, researchers reported.

According to the FRS, patients’ average risk of developing cardiovascular disease in the 10 years following diagnosis was 9.7 percent, researchers reported. But the actual rate of cardiovascular disease during that same time period was 17 percent. To put it another way, FRS scores predicted that 10 people in the group would develop cardiovascular disease. But in reality, 18 people developed cardiovascular disease, researchers reported.

This study is just the latest piece of evidence that many measurements of cardiovascular risk, such as the FRS or the SCORE tool, which is used in Europe, underestimate the risk of cardiovascular disease in people with psoriatic arthritis, according to Dr. Elaine Husni, a rheumatologist at the Cleveland Clinic and a member of the National Psoriasis Foundation Medical Board.

“All patients with inflammatory arthritis, whether it be rheumatoid arthritis or psoriatic arthritis, have an increased risk of cardiovascular disease,” Husni said. “Not everyone is going to get a heart attack who has psoriatic arthritis. But the chances are higher when you have it."

Currently, doctors don’t have a good way to determine cardiovascular risk in psoriatic arthritis patients, Husni said. Until a better screening tool is developed, she recommends that patients work with their doctors to determine their risk, and take steps to reduce it.

“At the Cleveland Clinic, we refer all of our inflammatory arthritis patients to a preventive cardiology department,” she said. If patients don’t have a preventive cardiologist in their area, they can also see their primary care physician.

Patients should check for traditional risk factors like weight, blood pressure and cholesterol levels, Husni said. Once they know their risk level, they can take any needed steps to reduce it, ranging from diet and exercise changes to medication use, she said.

Newer tests, such as blood tests and special imaging techniques, may also be used in some patients to help determine cardiovascular risk, Husni said.


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