H. Gouze, P. Aegerter, Y. Gouyette, et al., Rheumatology, 16 February 2024
April 1, 2025, midnight
Presented By
Dr Walter Maksymowych
MB ChB, FRCP(C), FACP
Chief Medical Officer, CARE Arthritis; Professor of Medicine, University of Alberta
Synopsis
Introduction
Cardiovascular (CV) and metabolic diseases represent the most frequent comorbidities in patients with PsA and axSpA, with a prevalence reaching 12% in SpA (Zhao et al.) and 19% in PsA (Gupta et al.).
Increased risk may be related to chronic inflammation, treatments (NSAIDs, steroids), and other risk factors (e.g., hypertension).
Meta-analysis of controlled observational studies assessed CVD risk over time in SpA and PsA patients, with a secondary objective to evaluate if new therapies and a treat-to-target approach reduced such risk.
Methods
Systematic literature review (SLR) from 1990 to December 2021.
Main outcome: composite occurrence of CVD, including ischaemic heart disease (IHD), stroke, and CV-related death.
Studies included had a follow-up period of at least 5 years.
Prespecified adjustments: age, gender, CV risk factors, and comorbidities.
Random-effects model and inverse variance method used to estimate pooled hazard ratios (HRs) with 95% confidence intervals (CIs).
Results
24 manuscripts included: 16 on SpA (113,827 cases) and 10 on PsA (93,118 cases), with 2 studies covering both.
SpA patients had an increased CVD incidence compared to the general population (pooled HR 1.45; 95% CI 1.22–1.72), also for individual CVS events.
PsA patients showed increased CVD incidence compared to the general population (pooled HR 1.28; 95% CI 1.15–1.43), excluding death.
Incident CVD rates in PsA patients decreased over time.
bioDMARD therapies were associated with reduced CVD risk, particularly in SpA.
NSAID effects on CVD risk were inconsistent, with some studies indicating increased risk from recent use, while others showed decreased overall incidence.
Video
Commentary
Patients should be made aware that poorly controlled inflammation in axSpA and PsA is associated with an increased risk for cardiovascular events. There is evidence, particularly, for bioDMARDs that this risk is reduced. This may be particularly relevant in patients who have other risk factors for such events. The impact of NSAID use is difficult to examine because patients often take these medications on an as required basis, which is not captured in most databases.
Patients should be made aware that poorly controlled inflammation in axSpA and PsA is associated with an increased risk for cardiovascular events. There is evidence, particularly, for bioDMARDs that this risk is reduced. This may be particularly relevant in patients who have other risk factors for such events. The impact of NSAID use is difficult to examine because patients often take these medications on an as required basis, which is not captured in most databases.