Aim In patients with psoriatic disease (PSD), we determined whether cardiac troponin I (cTnI) and N-terminal brain-type natriuretic peptide (NT-proBNP) were associated with carotid plaque burden and the development of cardiovascular (CV) events. independent of the Framingham risk score (FRS). Methods Among 1000 PsD patients, total carotid plaque area (TPA) was measured in 358 participants at baseline. cTnI and NT-proBNP were measured by automated clinical assays. The association between cardiac biomarkers and carotid atherosclerosis was evaluated by multivariable regression after adjusting for CV risk factors. Improvement in prediction of CV events beyond FRS was tested using measures of discrimination and risk reclassification. Results In univariate analyses, cTnI (β coefficient 0.52 [95% CI 0.3, 0.74], p<0.001) and NT-proBNP (β coefficient 0.24 [95% CI 0.1, 0.39] ], p<0.001) were associated with TPA. After adjusting for CV risk factors, the association remained statistically significant for cTnI (adjusted β coefficient 0.21 [95% CI 0, 0.41], p=0.047), but not for NT-proBNP (p=0. twenty-one). Among 1000 PsD patients evaluated for CV risk prediction, 64 patients had incident CV events. When comparing a base model (with FRS only) with expanded models (with FRS plus cardiac biomarkers), there was no improvement in predictive performance. Conclusion
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Biomarkers can predict cardiovascular risk in patients with psoriatic disease
Cardiac troponin I ( cTnI) and N-terminal pro-brain-like natriuretic peptide (NT-proBNP) were associated with incident cardiovascular events in patients with psoriatic disease.
Cardiac biomarkers may predict risk of atherosclerosis burden and other cardiovascular (CV) outcomes in patients with psoriasis and psoriatic arthritis (PsA), according to study findings recently published in Arthritis & Rheumatology.
Compared with the general population, patients with psoriatic disease (PsA and psoriasis) have been shown to have a higher risk of excess CV morbidity and mortality. However, the researchers noted that conventional cardiovascular risk scores, such as the Framingham risk score (FRS), underestimate cardiovascular risk in patients with psoriatic disease and other inflammatory rheumatic diseases.
“Most rely only on traditional CV risk factors and do not consider the independent risk conferred by immune disease,” the study authors said. "New laboratory and imaging biomarkers improve CV risk prediction in the general population, and it has been suggested that they could be combined with conventional scoring systems to optimize CV risk stratification."
With previous research identifying cardiac troponin I (cTnI) and N-terminal brain-type natriuretic peptide (NT-proBNP) as potential biomarkers to increase existing CV scores, the investigators explored the association of 2 variables with the presence and progression of carotid atherosclerosis in patients with psoriatic disease.
“In the context of current treatment guidelines that highlight the need to identify patients with psoriatic disease who are at high CV risk, we determined whether these cardiac biomarkers predict clinical CV events independently of traditional CV risk factors and whether they improve the CV risk stratification beyond FRS. ", they added.
The study authors recruited patients from the University of Toronto psoriatic disease cohort who provided a serum sample in the cohort biobank, had no history of cardiovascular events at study entry, and were followed for at least one year after the study. entrance to the studio.
Of the 1000 patients with psoriatic disease included in the cohort (PsA; n = 648; psoriasis; n = 352), total carotid plaque area (TPA), measured by ultrasound evaluation, was performed in 358 participants at baseline .
Cardiac biomarkers cTnI and NT-proBNP were measured by automated clinical trials, in which their association with carotid atherosclerosis was assessed by multivariable regression after adjusting for CV risk factors. Improvement in prediction of CV events beyond FRS was tested using measures of discrimination and risk reclassification.
In the results of the univariate analyses, both cTnI (β coefficient, 0.52; 95% CI, 0.3-0.74; P < 0.001) and NT-proBNP (β coefficient, 0.24; 95% CI, 0.1-0.39; P < 0.001) were associated with TPA. The association remained statistically significant for cTnl after adjusting for CV risk factors (adjusted β coefficient, 0.21; 95% CI, 0-0.41; P = 0.047), but not for NT-proBNP (P = 0.21).
A total of 64 of 1000 patients with psoriatic disease evaluated for CV risk prediction were shown to report incident CV events (10 angina; 20 myocardial infarction; 7 transient ischemic attack; 11 ischemic stroke; 11 revascularization; 5 CV death) .
Regarding the prediction of cardiovascular events beyond FRS, no significant improvement in predictive accuracy was observed when comparing a base model (with FRS alone) with expanded models (with FRS plus cardiac biomarkers).
“Our study provides new insights into the pathophysiology of cardiovascular diseases in psoriasis and psoriatic arthritis. However, at this time, ordering cardiac biomarker testing for risk stratification of asymptomatic patients with psoriatic disease is not recommended,” said senior author Lihi Eder, MD, PhD, associate professor of medicine at Women’s College Hospital and the University of Toronto.
