Cardiovascular risk markers in patients with psoriatic arthritis: A meta-analysis of literature studies

Figures & data

Table I. Demographic and clinical data of psoriatic arthritis patients and healthy controls in included studies.

Author	Pop (n)	M/F	Age (y)	HT (%)	Smoking (%)	DM (%)	Ob (%)	HL (%)	BMI (kg/m^2)	TC (mg/dL)	LDLc (mg/dL)	HDLc (mg/dL)	TGs (mg/dL)
Atzeni, 2011
PsA	22	12/10	54.9	–	9.1	–	–	–	27.6	197.1	109.9	44.6	175.5
Healthy	35	19/16	55.4	–	0	–	–	–	26.1	176.3	–	–	153.7
Bilgen, 2013^a
PsA	32	–	–	–	–	–	–	–	28.4	–	–	51	–
Healthy	37	–	–	–	–	–	–	–	–	–	–	–	–
Contessa, 2009
PsA	41	31/10	51.9	–	24.4	12.2	–	14.6	26.5	–	–	–	–
Healthy	41	31/10	52.1	–	21.9	0	–	31.7	25.6	–	–	–	–
Di Minno, 2011
PsA	224	104/120	52.6	41.1	28.6	8.9	62.5	51.8	–	–	–	–	–
Healthy	305	132/173	51.9	35.4	33.4	9.2	64.6	55.1	–	–	–	–	–
Eder, 2008
PsA	40	12/28	57.8	47.5	12.5	12.5	–	37.5	28.0	194.0	122.0	46.0	155.0
Healthy	40	12/28	57.0	47.5	17.5	12.5	–	37.5	27.0	211.0	131.0	53.0	149.0
Gentile, 2011^a
PsA	50	26/24	49.5	21.6	–	–	–	–	27.7	200.9	129.6	47.4	119.3
Healthy	100	44/56	47.3	21.6	–	–	–	–	25.9	190.7	122.0	50.5	90.7
Gonzalez-Juanatey, 2007
PsA	59	31/28	48.8	–	–	–	–	–	25.6	194.7	116.8	53.8	90.0
Healthy	59	31/28	48.8	–	–	–	–	–	25.4	185.9	111.5	51.9	97.4
Karadag, 2010
PsA	24	–	–	–	–	–	–	–	–	–	–	–	–
Healthy	50	–	–	–	–	–	–	–	–	–	–	–	–
Kimhi, 2007
PsA	47	23/24	50.0	25.0	34.0	10.6	–	29.0	27.7	207.0	128.0	54.0	126.0
Healthy	100	49/51	34.9	3.0	28.0	1.0	–	13.0	23.0	183.0	105.0	60.0	95.0
Magro-Checa, 2013^a
PsA	77	40/37	47.3	–	–	–	–	–	–	–	–	–	–
Healthy	77	40/37	47.3	–	–	–	–	–	–	–	–	–	–
Peluso, 2009^b
PsA	50	19/31	37.6	0	0	0	0	0	–	–	–	–	–
Healthy	50	21/29	36.8	0	0	0	0	0	–	–	–	–	–
Profumo, 2012
PsA	25	17/8	–	8.0	28.0	0	–	–	–	–	–	–	–
Healthy	13	–	–	–	–	0	–	0	–	–	–	–	–
Puato, 2014 (NT)
PsA	19	12/7	47.8	0	32.0	0	–	0	24.8	193.0	121.0	47.0	128.0
Healthy	38	20/18	48.8	0	26.0	0	–	25.0	24.9	209.0	131.0	51.0	131.0
Puato, 2014 (HT)
PsA	23	19/4	54.3	100	17.0	0	–	26.0	27.7	220.0	142.0	55.0	119.0
Healthy	23	16/6	48.1	100	26.0	0	–	26.0	27.1	217.0	144.0	52.0	118.0
Shang, 2012
PsA	43	23/20	53.0	–	–	0	–	–	24.2	–	–	–	–
Healthy	50	28/22	44.0	–	–	0	–	–	22.8	–	–	–	–
Sharma 2014
PsA	40	23/17	42.0	0	0	0	–	–	–	153.0	112.0	41.2	143.2
Healthy	40	27/13	39.0	0	0	0	–	–	–	142.0	89.3	36.8	134.0
Tam, 2008
PsA	82	42/40	49.0	50.0	10.0	23.2	15.0	14.6	23.4	199.0	113.0	55.0	118.0
Healthy	82	42/40	50.0	0	0	–	2.0	–	25.7	–	–	–	–

Age, BMI, TC, LDLc, HDLc, and TGs are expressed as mean values.

BMI = body mass index; DM = diabetes mellitus; HDLc = HDL-cholesterol; HL = hyperlipidemia; HT = hypertension; LDLc = LDL-cholesterol; M/F = male/female; NT = normotension; Ob = obesity; Pop = population; PsA = psoriatic arthritis; TC = total cholesterol; TGs = triglycerides.

^aOnly abstract available.

^bOnly abstract available; age is expressed as median value.

Table II. Measures of disease activity and data on treatment in psoriatic arthritis patients in included studies.

Author	PsA (n)	DAS28	BASDAI	BASFI	CRP (mg/dL)	ESR (mm/1 h)	Disease duration (y)	NSAIDs (%)	SSZ (%)	CS (%)	MTX (%)	anti-TNFα (%)
Atzeni, 2011	22	5.97	–	–	1.59	36.5	5.7	100	–	0	–	0
Bilgen, 2013^a	32	–	–	–	–	–	–	–	–	–	–	69
Contessa, 2009	41	–	35.0	25.9	0.46	15.1	10.1	–	–	–	–	–
Di Minno, 2011	224	–	–	–	2.73	18.8	9.1	0	12.5	0	27.7	53.6
Eder, 2008	40	–	–	–	1.13	38.0	8.5	57.5	20.0	12.5	57.5	12.5
Gentile, 2011^a	50	–	–	–	–	–	–	–	–	–	–	–
Gonzalez-Juanatey, 2007^b	59	2.40	–	–	0.84	17.7	7.8	100	5.0	57.6	86.4	3.4
Karadag, 2010	24	–	–	–	–	–	–	–	–	–	–	–
Kimhi, 2007	47	–	4.6	–	0.85	26.6	12.1	31.9	9.0	9.0	63.0	9.0
Magro-Checa, 2013^a	77	–	–	–	–	–	–	–	–	–	–	–
Peluso, 2009^a	50	–	–	–	–	–	–	–	–	–	–	0
Profumo, 2012	25	–	–	–	–	–	–	–	–	–	–	–
Puato, 2014 (NT)^c	19	–	–	–	0.11	–	–	–	–	–	–	–
Puato, 2014 (HT)^c	23	–	–	–	0.16	–	–	–	–	–	–	–
Shang, 2012^b	43	–	–	–	–	–	–	64.4	–	8.2	–	–
Sharma, 2014	40	–	–	–	–	–	3.4	–	–	–	–	–
Tam, 2008^d	82	3.40	4.4	1.7	–	–	9.4	–	13.4	2.4	32.9	1.2

DAS28, BASDAI, BASFI, CRP, ESR, and disease duration are expressed as mean values, unless otherwise indicated.

anti-TNFα = ongoing therapy with TNFα-blockers; BASDAI = Bath Ankylosing Spondylitis Disease Activity Index (clinical remission BASDAI < 2); BASFI = Bath Ankylosing Spondylitis Functional Index (clinical remission BASFI < 2); CRP = C-reactive protein; CS = ongoing therapy with corticosteroids; DAS28 = Disease Activity Score in 28 joints (clinical remission DAS28 < 2.6); ESR = erythrocyte sedimentation rate; HT = hypertension; MTX = ongoing therapy with methotrexate; NSAIDs = ongoing therapy with non-steroidal anti-inflammatory drugs; NT = normotension; PsA = psoriatic arthritis patients; SSZ = ongoing therapy with sulfasalazine.

^aOnly abstract available.

^bCurrent or previous corticosteroids use.

^cCRP level is expressed as median value.

^dBASFI is expressed as median value.

Figure 1. Common carotid artery intima-media thickness (CCA-IMT) in psoriatic arthritis (PsA) patients and controls.

Figure 2. Prevalence of carotid plaques in psoriatic arthritis (PsA) patients and controls.

Figure 3. Flow-mediated dilation (FMD) in psoriatic arthritis (PsA) patients and controls.

Figure 4. Nitrate-mediated dilation (NMD) in psoriatic arthritis (PsA) patients and controls.

Table III. Sensitivity analyses on ‘high quality’ studies (i.e. Newcastle–Ottawa Scale ≥ 7).

	n of studies	n of patients	Effect size; MD or OR [95% CI]
CCA-IMT	6 (6 data sets)	293 patients; 366 controls	MD: 0.09 [0.07, 0.12]; P < 0.00001 I^2 = 9%; P = 0.36
Carotid plaques	3 (3 data sets)	181 patients; 181 controls	OR: 4.53 [1.63, 12.62]; P = 0.004 I^2 = 34%; P = 0.22
FMD	3 (3 data sets)	114 patients; 140 controls	MD: –3.45 [–6.12, –0.77]; P = 0.01 I^2 = 93%; P < 0.00001
NMD	2 (2 data sets)	90 patients; 90 controls	MD: –0.56 –1.84, 0.72]; P = 0.39 I^2 = 0%; P = 0.89

95% CI = 95% confidence intervals; CCA-IMT = common carotid artery intima-media thickness; FMD = flow-mediated dilation; MD = mean difference; n = number; NMD = nitrate-mediated dilation; OR = odds ratio.

Table IV. Sensitivity analyses after exclusion of studies providing a composite IMT.

	n of studies	n of patients	Effect size; MD [95% CI]
CCA-IMT	7 (7 data sets)	511 patients; 663 controls	MD: 0.06 [0.01, 0.11]; P = 0.03 I^2 = 82%; P < 0.0001

95% CI = 95% confidence intervals; CCA-IMT = common carotid artery intima-media thickness; MD = mean difference; n = number.