Primary care-based screening for cardiovascular risk factors in patients with psoriasis

Abstract

Background: Studies assessing cardiovascular disease (CVD) risk factors in patients with psoriasis have been limited by selection bias, inappropriate controls or a reliance on data collected for clinical reasons.

Objectives: To investigate whether screening for CVD risk factors in patients with psoriasis in primary care augments the known prevalence of CVD risk factors in a cross-sectional study.

Methods: Patients listed as having psoriasis in primary care were recruited, screened and risk assessed by QRISK2.

Results: In total, 287 patients attended (mean age 53 years, 57% women, 94% white British, 22% severe disease, 33% self-reported psoriatic arthritis). The proportion with known and screen-detected (previously unknown) risk factors was as follows: hypertension 35% known and 13% screen-detected; hypercholesterolaemia 32% and 37%; diabetes 6·6% and 3·1% and chronic kidney disease 1·1% and 4·5%. At least one screen-detected risk factor was found in 48% and two or more risk factors were found in 21% of patients. One in three patients (37%) not previously known to be at high risk were found to have a high (> 10%) 10-year CVD risk. Among the participants receiving treatment for known CVD risk factors, nearly half had suboptimal levels for blood pressure (46%) and cholesterol (46%).

Conclusions: Cardiovascular risk factor screening of primary care-based adults with psoriasis identified a high proportion of patients (i) at high CVD risk, (ii) with screen-detected risk factors and (iii) with suboptimally managed known risk factors. These findings need to be considered alongside reports that detected limited responses of clinicians to identified risk factors before universal CVD screening can be recommended.

Figure 1

Proportion of Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) study participants with known and screen‐detected cardiovascular disease risk factors. Data are proportions of IMPACT study participants. ‘Known’ is the sum of (i) self‐report, (ii) medical or nursing staff knowing about this risk factor and (iii) medication for this risk factor. High blood pressure was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. High cholesterol was defined as total cholesterol ≥ 5 mmol L⁻¹. Diabetes was defined by high glycated haemoglobin ≥ 48 mmol mol^‐1. Chronic kidney disease was defined by low estimated glomerular filtration rate < 60 mL min^‐1.

Figure 2

Prevalence of combined known and screen‐detected cardiovascular risk factors in Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) study and Health Survey for England participants. Data are proportions (95% confidence interval) of IMPACT study and Health Survey for England participants with suboptimal risk factor status. Statistical significance for between‐cohort comparisons is denoted by *P < 0·05; **P < 0·001. Prevalence of high cholesterol was not significant (P = 0·08) after excluding IMPACT study patients with psoriasis taking methotrexate. High cholesterol was defined as self‐reported hypercholesterolaemia or lipid‐lowering therapy or total cholesterol > 5 mmol L⁻¹. High blood pressure was defined as self‐reported hypertension or use of antihypertensive therapy or systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. High glycated haemoglobin (HbA_1c) was defined as self‐reported diabetes or diabetes therapy or HbA_1c ≥ 48 mmol mol⁻¹. Obesity was defined as body mass index ≥ 30 kg m⁻². Smoking was defined as current use. Alcohol excess was defined as > 21 units per week for men and > 14 units per week for women.