University of Toronto, Toronto, Ontario, Canada.
Women's College Hospital, Toronto, Ontario, Canada.
Arthritis Rheumatol. 2019 Oct;71(10):1651-1659. doi: 10.1002/art.40925. Epub 2019 Sep 2.
This study aimed to assess whether subclinical atherosclerosis, as evaluated by carotid ultrasound, could predict incident cardiovascular events (CVEs) in patients with psoriatic disease (PsD) and determine whether incorporation of imaging data could improve CV risk prediction by the Framingham Risk Score (FRS).
In this cohort analysis, patients with PsD underwent ultrasound assessment of the carotid arteries at baseline. The extent of atherosclerosis was assessed using carotid intima-media thickness (CIMT) and total plaque area (TPA). Incident CVEs (new or recurrent) that occurred following the ultrasound assessment were identified. The association between measures of carotid atherosclerosis and the risk of developing an incident CVE was evaluated using Cox proportional hazards models, with adjustment for the FRS.
In total, 559 patients with PsD were assessed, of whom 23 had incident CVEs ascertained. The calculated rate of developing a first CVE during the study period was 1.11 events per 100 patient-years (95% confidence interval [95% CI] 0.74-1.67). When analyzed separately in Cox proportional hazards models that were controlled for the FRS, the TPA (hazard ratio [HR] 3.74, 95% CI 1.55-8.85; P = 0.003), mean CIMT (HR 1.21, 95% CI 1.03-1.42; P = 0.02), maximal CIMT (HR 1.11, 95% CI 1.01-1.22; P = 0.03), and high TPA category (HR 3.25, 95% CI 1.18-8.95; P = 0.02) were each predictive of incident CVEs in patients with PsD.
The burden of carotid atherosclerosis is associated with an increased risk of developing future CVEs. Combining vascular imaging data with information on traditional CV risk factors could improve the accuracy of CV risk stratification in patients with PsD.
本研究旨在评估颈动脉超声评估的亚临床动脉粥样硬化是否可以预测银屑病患者的心血管事件（CVE），并确定是否可以通过弗雷明汉风险评分（FRS）来改善影像学数据对心血管风险的预测。
在这项队列分析中，银屑病患者在基线时接受颈动脉超声检查。使用颈动脉内膜中层厚度（CIMT）和总斑块面积（TPA）评估动脉粥样硬化程度。确定在超声评估后发生的新发或复发性心血管事件（CVE）。使用 Cox 比例风险模型评估颈动脉粥样硬化程度与发生心血管事件风险之间的关系，模型中调整了 FRS。
共评估了 559 例银屑病患者，其中 23 例发生了心血管事件。在研究期间，首次发生心血管事件的发生率为每 100 名患者年 1.11 例（95%置信区间 [95%CI] 0.74-1.67）。在 Cox 比例风险模型中分别分析时，模型中控制了 FRS，TPA（风险比 [HR] 3.74，95%CI 1.55-8.85；P = 0.003）、平均 CIMT（HR 1.21，95%CI 1.03-1.42；P = 0.02）、最大 CIMT（HR 1.11，95%CI 1.01-1.22；P = 0.03）和高 TPA 类别（HR 3.25，95%CI 1.18-8.95；P = 0.02）与银屑病患者新发心血管事件均具有相关性。
颈动脉粥样硬化的负担与未来发生心血管事件的风险增加相关。将血管影像学数据与传统心血管危险因素信息相结合，可能会提高银屑病患者心血管风险分层的准确性。
