POS1086 HIGH CARDIOVASCULAR RISK IN PATIENTS WITH PSORIATIC ARTHRITIS: EVALUATION OF MACROANGIOPATHY AND ITS PREDICTORS BY AORTIC PULSE WAVE VELOCITY

Background

Systemic inflammatory rheumatic diseases are associated with macroangiopathy and increased cardiovascular (CV) risk [1, 2]. Psoriatic arthritis (PsA) has also been associated with an increased risk of CV events. However, data on diagnostic CV markers in PsA are scarce. Carotid-femoral pulse wave velocity (cfPWV; oscillometric diagnostic method) is considered to be the gold standard evaluation method of aortic stiffness and is used in the general population to assess CV risk (Figure 1). Moreover, EULAR and the European Society of Cardiology (ESC) recommend the use of Systematic Coronary Risk Evaluation (ESC-SCORE) in order to screen and classify patients regarding CV risk.

Figure 1.

Measurement of aortal pulse wave velocity: pulse waves of carotid and femoral artery (Δt: time, L: distance between the two arteries, m/s: meters/second), modified after [3].

Objectives

Aim of this study was to evaluate aortic stiffness and CV risk in patients with PsA based on measurements of cfPWV and ESC-SCORE. Moreover, we sought to investigate associations of cfPWV with patient- and disease-associated characteristics, as well as with traditional CV risk factors.

Methods

cfPWV measurements were performed in patients with PsA from two large rheumatological medical departments in Germany, according to the classification criteria for psoriatic arthritis (CASPAR), and in healthy control subjects. In addition to assessing cfPWV, clinical and laboratory parameters were evaluated, traditional CV risk factors were documented, and the ESC-SCORE was determined. Differences in cfPWV measurements between the two groups and associations between cfPWV and patient- or disease-associated characteristics were examined statistically (correlation analyses, Mann-Whitney-U-Tests, ANOVA and multivariate regression analyses).

Results

112 patients with PsA [55.45%♀, median age: 55 years, IQR 47-63] and 88 healthy control subjects [81%♀, median age: 51 years, IQR 36.5-58] were recruited. cfPWV was significantly higher in PsA patients compared to the healthy control subjects (p < 0.001), even after the adjustment for the effect of confounding factors. In both the patient and the control group, cfPWV correlated with age (r =0.560, p <0.01 and r =0.638, p <0.01, respectively). In addition, cfPWV showed a moderate significant correlation with the ESC-SCORE (r =0.280, p =0.22) and a weak significant association with mean arterial pressure (rho =0.19, p =0.043) in the patient group. No statistical associations could be found between cfPWV and lipid levels, CRP levels or DAS28 (all; p>0.05). Moreover, no significant differences regarding cfPWV measurements could be observed between patients with and without active disease.

Conclusion

This is one of the largest CV surrogate marker studies in patients with PsA. We were able to show that PsA patients had significantly higher aortic stiffness values, and thus, a higher CV risk compared to healthy individuals. Therefore, cfPWV could be a useful tool for the identification of PsA patients at high-risk. The fact that aortic stiffness can be predicted by mean arterial pressure and ESC-SCORE could assist forming therapeutic strategies that would promote artery de-stiffening and thus CV risk lowering.

References

[1]Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17-28.

[2]Triantafyllias K, Cavagna L, Klonowski A, et al. Possible misclassification of cardiovascular risk by SCORE in antisynthetase syndrome: results of the pilot multicenter study RI.CAR.D.A. Rheumatology (Oxford). 2021 Mar 2;60(3):1300-1312.

[3]Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Hear J. 2006;27:2588–605

Disclosure of Interests

None declared

THU0366 SYSTEMATIC CORONARY RISK EVALUATION (SCORE) MISCLASSIFIES CARDIOVASCULAR RISK IN ANTISYNTHETASE SYNDROME: RESULTS OF THE PILOT MULTICENTRIC STUDY RI.CAR.D.A

Background:

Antisynthetase Syndrom (ASyS) is an autoimmune overlap disease characterized by antiaminoacyl-tRNA-synthetase (anti-ARS) antibodies and the classic triad of arthritis, myositis and interstitial lung disease (ILD) (1). Markers of cardiovascular (CV) or cerebrovascular (CVB) risk have never been examined in ASyS.

Objectives:

Aim of this study (RIsk of CARdiovascular Disease in ASyS: RI.CAR.D.A.) was to test the ability of an established traditional CV risk prediction score (Systematic Coronary Risk Evaluation-SCORE) and its EULAR modified version (mSCORE) to identify ASyS patients at high CV risk. Moreover, we sought to examine for the first time associations of CV surrogate markers with clinical and immunological ASyS parameters.

Methods:

SCORE/mSCORE and the gold standard marker of aortic stiffness (carotid-femoral pulse wave velocity-cfPWV) were examined in patients with ASyS and healthy controls in a multicenter setting (6 Rheumatology Centers). Moreover, sonography of the common- (CCA), internal- (ICA) and external- (ECA) carotid arteries was performed in subsets of both groups, evaluating carotid intima-media-thickness (cIMT), plaques and duplex-sonographic indices of CBV risk such as the resistance- (RI) and pulsatility-index (PI).

Figure 1.

Carotid Doppler surrogate markers of cardiovascular and cerebrovascular risk in controls and ASyS (case).cIMTCarotid intima media thickness;CAA(common-),ICA(internal),ECA(external) carotid artery;RIresistance index;PIpulsatility index. (all;p< 0.05)

Results:

We recruited 66 ASyS patients with different anti-ARS and 88 controls. According to mSCORE5/50 (10%) of the patients had high CV risk. However, cfPWV and carotid sonography (CS) revealed an increased CV risk in21.2%and subclinical carotid arteriosclerosis (plaques and/or cIMT>0.9 mm) (SCA) in85.7%of the patients respectively. ROC analyses showed similarly poor diagnostic performances of SCORE/mSCORE in comparison to cfPWV(>10 m/s) and SAC by areas under the curve (AUC) of0.56 (95%CI=0.39-0.73) and0.63 (95%CI=0.3-0.96),respectively. cfPWV and SCA were higher in ASyS patients compared to controls (padj=0.021andp=0.003, respectively). cfPWV and cIMT correlated in the patient group significantly with age (r=0.679; p<0.001 and r=0.664; p<0.001,respectively).Moreover, cfPWV correlated with BMI (padj=0.001) and diabetes(padj=0.043). ACC-RI and ACC-PI showed significant associations with a marker of myositis activity [creatine phosphokinase (CPK):r=0.629;p=0.012andr=0.574;p=0.032, respectively]. Finally, ACI-RI and ACI-PI values were higher in patients with ILD (both;p=0.039).

Conclusion:

This is the first report of higher aortic stiffness and SCA in ASyS patients compared to controls. Active myositis and presence of ILD were associated with higher CVB risk parameters. Furthermore, SCORE/mSCORE performed poorly in identifying patients at high CV risk and carotid arteriosclerosis compared to cfPWV and CS respectively. Thus, cfPWV and CS could improve CV and CBV screening in ASyS patients.

References:

[1]Cavagna L, et al. Clinical Spectrum Time Course in Anti Jo-1 Positive Antisynthetase Syndrome.Medicine2015;94:1144.

Disclosure of Interests:

None declared