SAT0362 DEPRESSIVE SYMPTOMS ARE ASSOCIATED WITH A GREATER CARDIOVASCULAR RISK IN PATIENTS WITH PSORIATIC ARTHRITIS.
Authors: Gerlando Natalello, Enrico De Lorenzis, Dario Bruno, Giacomo Tanti, Maria Rosaria Magurano, Barbara Tolusso, Giusy Peluso, Elisa Gremese
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Cardiovascular (CV) events are the leading cause of death in patients with psoriatic arthritis (PsA) but current cardiovascular risk prevention strategies in these subjects appear to be inadequate. The prevalence of depressive symptoms, even in the absence of a diagnosed depressive disorder, is greater in patients with PsA than in the general population. <h3>Objectives:</h3> The objective of the study is to evaluate the association between CV risk factors and depressive symptoms in a cohort of patients with PsA. <h3>Methods:</h3> We enrolled consecutive patients with PsA (CASPAR criteria) without a diagnosis of major depression or history of major CV events. The presence of significant depressive symptoms was defined by the Hospital Anxiety and Depression Scale (HADS) for scores ≥ 8. The subjects were characterized by disease phenotype, duration and activity (according to the DAPSA index) and immunosuppressive, antihypertensive, glucose-, urate- and lipid-lowering therapy. In order to assess the prevalence of traditional CV risk factors, patients were characterized by BMI, waist and hip circumference, blood pressure (BP), smoking habits, physical activity and familiarity for myocardial infarction, lipid, glucose and serum urate. The predicted risk of CV events was calculated by the Framingham Risk Score (FRS), Atherosclerotic Cardiovascular Disease (ASCVD) score and Systematic COronary Risk Evaluation (HeartSCORE) risk charts. <h3>Results:</h3> One-hundred patients with PsA were enrolled (males 47.0%, mean age 54.9±12.5 years, duration of illness 9.1±10.6 years) of which 20.6% were in remission, 43.3% in low disease activity, 28.8% in moderate disease activity and 10.3% in high disease activity according to DAPSA; 38% had significant depressive symptoms according to the HADS questionnaire. Patients without depressive symptoms had a higher mean age (57.8±12.3vs52.1±12.4 years, p=0.002) compared to patients with significant depressive symptoms but were comparable according to M:F ratio, duration and domains of psoriatic disease, PASI, DAPSA and immunosuppressive therapy. The presence of depressive symptoms was associated with a higher prevalence of obesity (34.2%vs9.7%, p=0.002) and "at risk" abdominal circumference (84.2%vs61.3%, p=0.015) and hip/waist ratio (81.6%vs50.0%, p=0.002). Moreover, these patients had more frequently a history of active or previous smoking (63.2%vs.40.3%, p=0.027) but did not differ according to lifestyle, BP, antihypertensive therapy or familiarity with myocardial infarction compared to patients without depressive symptoms. With regard to the metabolic profile, patients with and without depressive symptoms did not differ in terms of exposure to lipid- and glucose-lowering drugs and fasting glucose values. However, patients with depressive symptoms had increased atherogenic risk index more frequently (76.3%vs54.8%, p=0.046) and greater LDL/HDL ratio (2.6±1.2vs2.1±0.7, p=0.017) and serum triglycerides values (135.1±53.7 mg/dl vs 108.8±58.6 mg/dl, p=0.046). The estimated risk of cardiovascular events at 10 years for traditional risk factors was greater for patients with depressive symptoms (FRS 16.8±12.3vs10.4 ± 6.0, p=0.003; HeartSCORE 1.9±1.5vs1.1±1.0, p=0.011; ASCVD 11.7±8.8vs7.8±8.4, p=0.05). <h3>Conclusion:</h3> The presence of depressive symptoms is associated with a higher incidence of modifiable CV risk factors and a higher predicted risk of CV events in patients with PsA. Systematic research of depressive symptoms in patients with PsA could contribute to the correct assessment of CV risk, helping to implement more effective prevention strategies. <h3>Disclosure of Interests:</h3> Gerlando Natalello: None declared, Enrico De Lorenzis: None declared, Dario Bruno: None declared, Giacomo Tanti: None declared, Maria Rosaria Magurano: None declared, Barbara Tolusso: None declared, Giusy Peluso: None declared, Elisa Gremese Consultant for: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Sanofi, UCB, Roche, and Pfizer, Speakers bureau: BMS, Speakers bureau: Roche, Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Sanofi, UCB, Roche, and Pfizer