Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Department of Diagnostic and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Ann Rheum Dis. 2017 Jul;76(7):1237-1244. doi: 10.1136/annrheumdis-2016-210390. Epub 2017 Jan 4.
To evaluate coronary atherosclerosis in patients with psoriatic arthritis (PsA) and control subjects using coronary CT angiography (CCTA).
Ninety consecutive patients with PsA (male: 56(62.2%); 50.3±11.1 years) were recruited. 240 controls (male: 137(57.1%); 49.6±10.7 years) without known cardiovascular (CV) diseases who underwent CCTA due to chest pain and/or multiple CV risk factors were recruited for comparison.
Patients with PsA and controls were matched in age, gender and traditional CV risk factors (all p>0.2). The prevalence of overall plaque (54(60%)/84(35%), p<0.001), calcified plaque (CP) (29(32%)/40(17%), p=0.002), mixed plaque (MP) (20(22%)/18(8%), p<0.001), non-calcified plaque (NCP) (39(43%)/53(22%), p<0.001) and combined MP/NCP (46(51%)/62(26%), p<0.001) were all significantly higher in patients with PsA. Three-vessel disease was diagnosed in 12(13%) patients with PsA and 7(3%) controls (p<0.001), while obstructive plaques (>50% stenosis) were observed in 8(9%) patients with PsA and 7(3%) controls (p=0.033). After adjusting for traditional CV risk factors, PsA remained an independent explanatory variable for all types of coronary plaques (OR: 2.730 to 4.064, all p<0.001). PsA was also an independent explanatory variable for three-vessel disease (OR: 10.798, p<0.001) and obstructive plaque (3.939, p=0.024). In patients with PsA, disease duration was the only disease-specific characteristic associated with more vulnerable plaques (MP/NCP) in multivariate analysis (1.063, p=0.031). The other independent explanatory variables were age ≥55 years (5.636, p=0.005) and male gender (8.197, p=0.001).
Patients with PsA have increased prevalence, burden and severity of coronary atherosclerosis as documented by CCTA. Longer disease duration was independently associated with the presence of vulnerable MP/NCP plaques in patients with PsA.
NCT02232321.
使用冠状动脉 CT 血管造影术 (CCTA) 评估银屑病关节炎 (PsA) 患者和对照者的冠状动脉粥样硬化情况。
连续招募了 90 例患有 PsA（男性：56（62.2%）；50.3±11.1 岁）的患者。因胸痛和/或多种心血管 (CV) 危险因素而接受 CCTA 的 240 名对照者（男性：137（57.1%）；49.6±10.7 岁）无已知心血管疾病，被招募作为对照进行比较。
PsA 患者和对照组在年龄、性别和传统 CV 危险因素方面相匹配（均 p>0.2）。总体斑块的患病率（54（60%）/84（35%），p<0.001）、钙化斑块（CP）（29（32%）/40（17%），p=0.002）、混合斑块（MP）（20（22%）/18（8%），p<0.001）、非钙化斑块（NCP）（39（43%）/53（22%），p<0.001）和混合 MP/NCP（46（51%）/62（26%），p<0.001）在 PsA 患者中均显著更高。12 例 PsA 患者（13%）和 7 例对照者（3%）诊断为三血管疾病（p<0.001），而 8 例 PsA 患者（9%）和 7 例对照者（3%）观察到阻塞性斑块（>50%狭窄）（p=0.033）。在调整传统 CV 危险因素后，PsA 仍然是所有类型冠状动脉斑块的独立解释变量（OR：2.730 至 4.064，均 p<0.001）。PsA 也是三血管疾病（OR：10.798，p<0.001）和阻塞性斑块（3.939，p=0.024）的独立解释变量。在 PsA 患者中，疾病持续时间是多变量分析中唯一与更易损斑块（MP/NCP）相关的疾病特异性特征（1.063，p=0.031）。其他独立的解释变量是年龄≥55 岁（5.636，p=0.005）和男性（8.197，p=0.001）。
使用 CCTA 证实银屑病关节炎患者的冠状动脉粥样硬化发生率、负担和严重程度增加。在 PsA 患者中，较长的疾病持续时间与易损的 MP/NCP 斑块的存在独立相关。
NCT02232321。
