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Should all patients with psoriasis receive statins? Analysis according to different strategies
Walter Masson1, Martín Lobo2, Graciela Molinero2
1Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Council of Epidemiology and Cardiovascular Prevention, Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
Insights
Patients with psoriasis face significant cardiovascular risk. Two major guidelines suggest similar statin therapy indications for over 60% of these individuals, highlighting a need for proactive cardiovascular risk management.
Area of Science:
- Cardiology
- Dermatology
- Public Health
Background:
- Psoriasis is associated with increased cardiovascular risk.
- Effective cardiovascular risk management strategies are crucial for patients with psoriasis.
- Existing guidelines offer different approaches to cardiovascular risk assessment and prevention.
Purpose of the Study:
- To estimate cardiovascular risk in patients with psoriasis.
- To evaluate two distinct cardiovascular prevention strategies (ACC/AHA and ESC/EAS guidelines).
- To determine the proportion of psoriasis patients eligible for statin therapy under these guidelines.
Main Methods:
- Retrospective cohort study using a secondary database.
- Inclusion of adult patients (>18 years) with psoriasis, excluding those with pre-existing cardiovascular disease or on lipid-lowering treatment.
- Calculation of cardiovascular risk using the 2018 ACC/AHA atherosclerotic cardiovascular disease (ASCVD) calculator and the 2016 ESC/EAS Systematic Coronary Risk Evaluation (SCORE) calculator, with SCORE adjusted by a factor of 1.5.
Main Results:
- A cohort of 892 patients (mean age 59.9 years, 54.5% women) was analyzed.
- Risk stratification revealed a significant proportion of patients at moderate-to-high cardiovascular risk by both ASCVD (69.3%) and SCORE (30.6%) calculators.
- Both guidelines indicated statin therapy for a similar proportion of patients: 60.1% (ACC/AHA) and 60.9% (ESC/EAS).
Conclusions:
- The study population with psoriasis exhibited predominantly moderate-to-high cardiovascular risk.
- Cardiovascular risk assessment using either the ACC/AHA or ESC/EAS guidelines resulted in comparable recommendations for statin therapy initiation.
- These findings underscore the high cardiovascular burden in psoriasis patients and the potential utility of guideline-directed statin therapy.
Background:
Different strategies have been proposed for the cardiovascular risk management of patients with psoriasis.
Objective:
To estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy.
Methods:
A retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed.
Results:
A total of 892 patients (mean age 59.9±16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1-27.0%) and 1.9% (IQR 0.4-5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively.
Study Limitations:
This was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis.
Conclusion:
This population with psoriasis was mostly classified at moderate-high risk and the statin therapy indication was similar when applying the two strategies evaluated.
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