Cardiac troponin I (cTnI) level may reflect atherosclerosis burden independent of traditional cardiovascular (CV) risk factors in patients with psoriatic disease (PsD), according to study findings published in Arthritis & Rheumatology.
Investigators sought to determine whether cTnI and N-terminal pro-brain-type natriuretic peptide (NT-proBNP) were associated with carotid plaque burden and CV events independent of the Framingham Risk Score (FRS).
Atherosclerotic plaque burden was measured with carotid total plaque area (TPA), and the FRS was calculated for each patient to estimate the 10-year risk for CV disease. The first clinical CV event was the primary endpoint.
Ultrasound assessment was conducted in 358 patients with PsD (mean age, 53.8 ± 11 years; 45.8% women), and the mean ± SD follow-up was 3.69 ± 1.9 years. A total of 1000 patients with PsD assessed for CV risk prediction were also included (mean age, 49 ± 12.8 years; 44.6% women).
Univariate analyses showed that TnI (β coefficient 0.52; 95% CI, 0.3, 0.74) and NT-proBNP (β coefficient 0.24; 95% CI, 0.1, 0.39) were associated with TPA. The association remained statistically significant for TnI (adjusted β coefficient 0.21; 95% CI, 0, 0.41), but not for NT-proBNP, after adjustment for CV risk factors, lipid-lowering therapy, and creatinine.
TnI was associated with atherosclerosis progression (odds ratio [OR] 1.52; 95% CI, 1.04, 2.23), but not NT-proBNP (OR 1.08; 95% CI, 0.87, 1.34) in the univariate analysis. Current smoking, creatinine level, and baseline TPA predicted atherosclerosis progression in the multivariable analysis.
After a mean follow-up of 7.1 years among the 1000 participants with PsD, 64 developed an incident CV event, with an incidence rate of 0.9 events per 100 person-years (95% CI, 0.7, 1.0).
No significant improvement in predictive accuracy was observed after comparing a base model with the FRS alone to expanded models with the FRS and cardiac biomarkers. The addition of cTnI, NT-proBNP, or both cTnI and NT-proBNP to the FRS did not result in improvement in any measure of risk discrimination or reclassification, it was noted.
Study limitations include the relatively small number of CV events, which prevented subgroup analysis by disease group. In addition, a comparator group of patients without psoriatic disease was not included.
“cTnI may be as effective as established measures of carotid plaque burden for identifying subclinical atherosclerosis long before CV events occur,” stated the researchers. “Both cTnI and NT-proBNP are associated with incident CV events independent of traditional CV risk factors and may reflect the excess risk in patients with PsD. However, the lack of improvement in prediction metrics beyond the FRS does not support the routine use of these cardiac biomarkers for CV risk stratification in asymptomatic patients with PsD.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Colaço K, Lee K-A, Akhtari S, et al. Association of cardiac biomarkers with cardiovascular outcomes in patients with psoriatic arthritis and psoriasis: a longitudinal cohort study. Arthritis Rheumatol. Published online March 8, 2022. doi:10.1002/art.42079