Performance of traditional cardiovascular risk calculators Vs imaging diagnosis of atherosclerosis in patients with psoriatic arthritis
Authors: Florez Mausa M , Jadon J D , Cacciottolo P C 
Published: June 2024

Abstract

Introduction
Cardiovascular events are the leading cause of mortality in patients with psoriatic arthritis (PsA) 4. This is attributed to a high-risk factor burden that has been previously correlated to disease activity and multi-morbidity 7. At present there is no clear guidance on how to best estimate cardiovascular risk in PsA 1, 3.

Methods
The records of 284 adult patients (18-70 years old) seen in our local PsA clinic from 2018 to 2022 were reviewed. Patients with prior MACE, heart failure or known atherosclerosis were excluded. We matched the performance of QRISK3 and SCORE2 to pre-existing diagnostic imaging with evidence of coronary or extra-coronary atherosclerosis 2, 5, 8.

Results
253 patients were eligible for analysis: Age range 40-69 (mean of 55 (SD 8.2). 138 (54.5%) were female. 41 (17%) were smokers, 116 (49%) were ex-smokers. 67 (26%) patients had a prior diagnosis of hypertension and of them 49 (73%) were uncontrolled. 18 patients had Diabetes. 36 (15%) had a normal BMI, 80 (33%) were overweight, 101 (41%) were obese, and 27 (11%) were morbidly obese. Mean LDLc was 2.97 mmol/L (115 mg/dL SD 0.87), mean HDL was 1.4 mmol/L (54 mg/dL SD 0.4), mean triglycerides were 2 mmol/L (77 mg/dL SD 1.27). CRP ranged from 4-50 mg/L (mean of 7.2 mg/L (SD 8)), with 73% having a normal CRP (&lt;10 mg/L)
173 patients (68%) and 203 (80%) had enough information in their records to allow for QRISK3 and SCORE2 calculation respectively. QRISK3 classified patients as 80 (46%) high, and 40 (23%) moderate risk. SCORE2 classified them as 8 (4%) very high, 94 (46%) high, and 101 (50%) moderate risk.
74 (29%) patients had pre-existing imaging, 7 CTCA, and the rest non-dedicated CT.
52 patients had a QRISK3, and 62 patients had a SCORE2 calculation available. Atherosclerosis was confirmed in 31/52 (60%) QRISK3 patients (20/25 with high risk, and 11/27 with non-significant risk (5/12 moderate, 6/15 low, and 2 lower risk)), and in 29/62 (47%) SCORE2 patients (2/3 very high, 16/28 high, and 11/31 moderate risk).
QRISK3 x1.5 identified 8 and 7 of the moderate QRISK3 and SCORE2 patients with atherosclerosis, whilst SCORE2 x1.5 identified 5/8 moderate SCORE2 and 4/8 moderate QRISK3.
ROC curve: with atherosclerosis on imaging as gold standard, the area under the curve for QRISK3 was 0.809 (st error 0.055 p &lt;0.005 [0.702-0.916]), and for SCORE2 0.780 (st error 0.060 p &lt;0.005 [0.662-0.898]). Adjusted risk prediction tool curves overlapped, indicating an insufficient sample.
QRISK3 x1.5 maintained a higher sensitivity at high-risk values not compromising on specificity at low risk.

Conclusions
Poorly controlled metabolic risk factors and undiagnosed atherosclerosis are highly prevalent throughout the risk spectrum. Further PsA-specific validation and adjustment of traditional risk estimators are required to improve performance and facilitate population-specific policies that lead to timely primary prevention. Risk models Vs atherosclerosis in PsA