Disclosures: Eder reports no relevant financial disclosures. Co-author Dafna D. Gladman, MD, of the University of Toronto and the Krembil Research Institute, at Toronto Western Hospital, reports grants from The Krembil Foundation.
March 02, 2021
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Heart failure linked to disease activity, inflammation in patients with psoriatic disease

Disclosures: Eder reports no relevant financial disclosures. Co-author Dafna D. Gladman, MD, of the University of Toronto and the Krembil Research Institute, at Toronto Western Hospital, reports grants from The Krembil Foundation.
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Systemic inflammation burden and disease activity are independent risk factors for heart failure among patients with psoriatic disease, according to data published in Arthritis Care & Research.

“Heart failure occurs when the heart does not pump blood properly, which leads to difficulties in performing daily activities and may result in premature death,” Lihi Eder, MD, PhD, of Women’s College Hospital and the University of Toronto, told Healio Rheumatology. “Patients with psoriatic disease are at high risk to develop this condition, yet it is unclear what are the mechanisms linking these two diseases.”

“People with more active arthritis and psoriasis as well as those with higher levels of inflammatory blood markers, were at higher risk of heart failure,” Lihi Eder, MD, PhD, told Healio Rheumatology.

To determine the incidence of, and risk factors for, heart failure among patients with psoriatic disease, Eder and colleagues conducted a cohort analysis of individuals followed at the University of Toronto Psoriatic Disease clinic from 1978 to 2018. All patients in the cohort are assessed according to a standard protocol every 6 to 12 months.

For their study, the researchers included 1,994 patients from the cohort who had at least 1 year of follow-up and no history of heart failure prior to their first clinic visit. The primary outcome was the time to first heart failure event. For the secondary outcome, these heart failure events were classified as either ischemic or non‐ischemic. The researchers used Cox proportional hazards regression to assess the association between cardiovascular risk factors, measures of disease activity and heart failure events. They also described electrocardiographic and echocardiographic findings associated with heart failure.

Lihi Eder

According to the researchers, there were 64 heart failure events — 38 ischemic and 26 non‐ischemic — among the included patients. The incident rate for first heart failure event was 2.85 per 1,000 patient years, compared with 1.93 per patient years as reported in a recent study of residents in the same province, the researchers wrote. In all events, the most common electrocardiographic findings were atrial fibrillation, with 22%, and bundle branch blocks, at 29%. Echocardiogram demonstrated a 37% reduced ejection fraction and 63% preserved ejection fraction.

Independent risk factors for all heart failure events, according to the multivariable analysis, were ischemic heart disease, adjusted mean tender joint count, adjusted mean swollen joint count, adjusted mean erythrocyte sedimentation rate, adjusted mean C‐reactive protein, and physical function (all P < .05). Meanwhile, minimal disease activity status was protective for all heart failure (P < .05).

“Our study found that heart failure in patients with psoriatic disease is associated not only with the known cardiac risk factors, such as hypertension and diabetes, but also with the burden of inflammation related to the skin and joint disease,” Eder said. “People with more active arthritis and psoriasis as well as those with higher levels of inflammatory blood markers, were at higher risk of heart failure. This study highlights the importance of controlling inflammation in patients with psoriasis and psoriatic arthritis to potentially reduce the risk of future heart failure.”