FRI0366 CARDIOVASCULAR RISK RECLASSIFICATION USING CAROTID ULTRASOUND IN PSORIATIC ARTHRITIS: A CASE-CONTROL STUDY
Authors: D. Á. Galarza-Delgado, J. R. Azpiri-López, I. J. Colunga-Pedraza, D. E. Flores Alvarado, O. Ilizaliturri Guerra, I. C. Zárate Salinas, P. F. Frausto Lerma, A. Pérez Villar, M. A. Reyes Soto, A. C. Garza Acosta
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients with psoriatic arthritis (PsA) have an increased risk of cardiovascular disease (CVD). Risk stratification algorithms for general population, such as cardiovascular risk calculators, have been developed to improve primary prevention and early detection of CVD; however, it underestimates cardiovascular risk in PsA patients 1 . Carotid ultrasound, which measures both carotid intima-media thickness (cIMT) and carotid plaque (CP), is useful in the detection of subclinical carotid atherosclerosis improving risk stratification. Objectives: This study aimed to evaluate the use of carotid ultrasound in the reclassification of cardiovascular risk in PsA patients and compare it with controls. Methods: This cross-sectional study included 70 PsA patients that fulfilled the CASPAR criteria and 70 controls subjects matched by age and comorbidities. Patients with a history of previous atherosclerotic CVD and pregnancy were excluded. Clinical examination, blood tests and Framingham Risk Score Lipids and BMI based (FRS-Lipids/FRS-BMI) and ACC/AHA 2013 calculators were performed. Carotid B-mode ultrasonography was used for measurements of cIMT and CP presence. Increased cIMT was defined as ≥0.9 mm. CP was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or a cIMT ≥1.2 mm. Descriptive analysis was done with measures of central tendency and dispersion and comparisons with Chi-square, Student´s t and Mann-Whitney U tests. Results: A total of 138 subjects were included. Clinical and demographic characteristics are shown in Table 1. Differences were found in the cardiovascular risk classification between the calculators and the carotid ultrasound. However, these were not significant when compared to controls, with the exception of the FRS-Lipids which had a significant difference when recategorized as high risk by the increase in the cIMT (p = 0.016). A 70.8% and a 56% of patients with PsA who had CP were not classified as high risk according to FRS-Lipids (p = 0.010) and ACC / AHA 2013 (p &lt;0.001) respectively. Table 1. Clinical and demographic characteristics. PsA (n=69) Controls (n=69) P Age, (mean±SD) 53.58±10.946 53.86±7.313 NS Women, n (%) 38(55.1) 59(85.5) &lt;0.001 Type 2 Diabetes Mellitus, n (%) 14(20.3) 9(13) NS Hypertension, n (%) 27(39.1) 19(27.5) NS Dyslipidemia, n (%) 29(42) 24(34.8) NS Obese, n (%) 26(37.7) 28(40.6) NS Active smoker, n (%) 15(21.7) 12(17.4) NS Disease duration, median (q25-q75) 5(2.5-8) - - DAS28-ESR, (mean±SD) 3.74±1.477 - - DAPSA, median (q25-q75) 35(27.5-58.5) - - Conclusion: None of the traditional calculators used in the general population correctly estimates cardiovascular risk in patients with PsA. Among the calculators we performed, FRS-Lipids was the worst, underestimating PsA individuals with CP up to 70.8%. Therefore, it is advisable to perform a carotid ultrasound without relying on the results obtained by any of these calculators in order to achieve an adequate classification and accomplish a correct management of the disease. References: [1]Sobchak, C. et al. (2019), Value of Carotid Ultrasound in Cardiovascular Risk Stratification in Patients with Psoriatic Disease. Arthritis Rheumatology, 71: 1651-1659. doi:10.1002/art.40925 Table 2. Ultrasound Characteristics in PsA patients CP Without CP P FRS-Lipids, n (%) 0.010 Low and Moderate risk 17(70.8) 39(95.1) High risk 7(29.2) 2(4.9) FRS-BMI, n (%) NS Low and Moderate risk 15(62.5) 32(80) High risk 9(37.5) 8(20) ACC/AHA 2013, n (%) &lt;0.001 Low, Borderline and Moderate risk 14(56) 35(97.2) High risk 11(44) 1(2.8) Disclosure of Interests: None declared