POS1079 ASSOCIATION OF C-REACTIVE PROTEIN AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGS WITH CARDIOVASCULAR EVENTS IN PATIENTS WITH PSORIATIC ARTHRITIS: A TIME-DEPENDENT Cox REGRESSION ANALYSIS
Authors: S. H. M. Lam, H. So, I. T. Cheng, E. LI, P. C. Wong, T. K. LI, A. P. W. Lee, L. S. Tam
Journal: Annals of the Rheumatic Diseases (2021)

Background: Psoriatic arthritis (PsA) is associated with accelerated atherosclerosis due to underlying inflammation. Whether inflammatory burden and drugs used to suppress inflammation over time are associated with cardiovascular (CV) events remains unclear. Objectives: This study aims to examine the time-varying effect of C-reactive protein (CRP) levels and the use of drugs including non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of CV events independent of traditional CV risk factors in PsA patients. Methods: A retrospective cohort analysis was performed in patients with PsA who were recruited from 2008 to 2015 and followed till the end of 2019. The outcome was occurrence of a first CV event. Framingham risk score (FRS) was used to quantify the traditional CV risk. Cox proportional hazard models with time-varying CRP levels and drugs used were analyzed to identify the risk factors for CV events in PsA patients. Results: 200 patients with PsA (median age: 47.5[40.0 – 56.0]; male: 119 [59.5%]) were recruited (Table 1. next page). After a mean follow-up of 8.8±3.8 years, 30 (15%) patients developed a first CV event. The Kaplan-Meier survival analysis indicated a significant difference in the CV event-free survival between patients with and without CRP level &gt;3 mg/L (Figure 1A) and an inverse relationship between time-varying NSAIDs exposure and CV event-free survival (Figure 1B). The multivariable Cox regression model showed that time-varying CRP level (HR 1.02, 95% CI 1.00 to 1.04) and NSAIDs exposure (HR 0.30, 95% CI 0.15 to 0.95) were significantly associated with CV events after adjusting for baseline FRS (HR 5.04, 95% CI 1.83 to 13.85). Table 1. Baseline demographic and clinical characteristics, cardiovascular risk factors and treatments received. Variables All patients n=200 median (IQR) or n (%) CVD -ve, n=170 median (IQR) or n (%) CVD +ve, n=30 median (IQR) or n (%) p -value NSAID -ve, n=61 median (IQR) or n (%) NSAID +ve, n=139 median (IQR) or n (%) p -value Male, n (%) 119 (59.5%) 100 (58.6%) 19 (63.3%) 0.228 39 (63.9%) 80 (57.6%) 0.397 Age, years 47.5 (40.0 – 56.0) 46.5 (37.7 – 54.0) 57.0 (45.3 – 65.8) &lt;0.001* 49.0 (44.0 – 56.5) 46.0 (38.0 – 54.8) 0.176 Disease duration, years 4.3 (1.8 – 7.9) 4.1 (1.7 – 7.0) 6.0 (2.1 – 8.6) 0.066 4.6 (1.5 – 8.7) 4.3 (1.9 – 7.3) 0.393 Diabetes, n (%) 45 (22.5%) 30 (17.6%) 15 (50.0%) &lt;0.001* 10 (16.4%) 35 (25.2%) 0.171 Hypertension, n (%) 68 (34.0%) 46 (27.1%) 22 (73.3%) &lt;0.001* 21 (34.4%) 47 (33.9%) 0.933 CRP, mg/L 4.9 (1.7 – 12.6) 4.2 (1.5 – 12.0) 11.3 (2.4 – 19.6) 0.035* 5.5 (1.7 – 15.1) 7.2 (1.4 – 15.8) 0.770 ESR, mm/hr 21 (10.0 – 38.0) 20 (9 – 35) 31 (14 – 60) 0.038* 21 (7 – 33) 21 (11 – 43) 0.291 Systolic blood pressure, mmHg 125 (115 – 140) 124 (115 – 137) 144 (129 – 160) &lt;0.001* 123 (118 – 137) 125 (115 – 141) 0.889 Diastolic blood pressure, mmHg 78 (70 – 85) 78 (70 – 84) 82 (72 – 90) 0.199 78 (72 – 86) 78 (70 – 85) 0.697 FRS 8.4 (4.0 – 17.0) 7.5 (3.3 – 14.0) 19.6 (13.4 – 43.0) &lt;0.001* 7.9 (3.5 – 15.5) 8.7 (4.2 – 17.1) 0.885 Lipid-lowering drugs, n (%) 30 (15.0%) 25 (14.7%) 5 (16.7%) 0.782 9 (14.8%) 21 (15.1%) 0.949 MTX, n (%) 99 (49.5%) 81 (47.6%) 18 (60.0%) 0.212 25 (41.0%) 74 (53.2%) 0.111 bDMARDs, n (%) 17 (8.5%) 13 (7.6%) 4 (13.3%) 0.303 6 (9.8%) 11 (7.9%) 0.654 NSAIDs, n (%) 139 (69.2%) 119 (70.0%) 20 (66.7%) 0.715 N/A N/A N/A Steroid, n (%) 2 (1.0%) 2 (1.2%) 0 (0%) 1.000 1 (1.6%) 1 (0.7%) 0.518 *statistically significant at p≤ 0.05 CVD+ve, patients who developed cardiovascular events during subsequent follow-up; CVD-ve, patients who did not developed cardiovascular events during subsequent follow-up; NSAIDs, nonsteroidal anti-inflammatory drugs; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; FRS, Framingham Risk Score; MTX, methotrexate; bDMARDs, biological disease-modifying antirheumatic drugs. Conclusion: Increased inflammatory burden as reflected by elevated CRP level was associated with increased risk of CV events, while the risk was significantly reduced with NSAIDs use in PsA patients. Disclosure of Interests: None declared.