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Multisite Atherosclerosis and SCORE2-Based Risk Stratification in Psoriatic Arthritis: A Phenotype-Dependent Role of

Lilyan C Charca1, Ignacio Braña2, Marta Loredo2

  • 1Rheumatology Section, Fundació Hospital de l'Esperit Sant, 33011 Santa Coloma de Gramenet, Spain.

Biomedicines
|June 26, 2026
PubMed

Insights

Cardiovascular risk in psoriatic arthritis (PsA) is underestimated by focusing only on carotid arteries. Assessing multiple vascular beds like femoral and aortic arteries improves risk prediction over standard scores.

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Vascular Imaging

Background:

  • Psoriatic arthritis (PsA) is associated with increased cardiovascular (CV) risk.
  • Traditional vascular assessments in PsA patients often focus on carotid arteries, potentially missing broader systemic atherosclerosis.
  • A comprehensive evaluation of multiple vascular territories is needed to accurately assess CV risk in PsA.

Purpose of the Study:

  • To determine the prevalence and concordance of atherosclerotic plaques in carotid, femoral, and aortic territories in PsA patients.
  • To evaluate the added value of vascular imaging across these territories compared to the SCORE2 risk score.
  • To investigate the incremental predictive value of specific vascular territories for subclinical atherosclerosis and multiterritorial disease.

Main Methods:

  • Cross-sectional study of 250 PsA patients.
  • Carotid and femoral ultrasound, and abdominal X-ray for plaque assessment.
  • Evaluation of plaque prevalence, multiterritorial involvement, and agreement between vascular beds.
  • Analysis of incremental value over SCORE2 using ROC curves, decision curve analysis (DCA), and reclassification metrics in patients aged 50-69.

Main Results:

  • Plaque prevalence: carotid (36.0%), femoral (62.8%), aortic (31.6%). Multiterritorial involvement observed in 43.2% of patients.
  • Moderate agreement (κ ≈ 0.35) between vascular territories; 48.1% of patients without carotid plaques had femoral involvement.
  • Vascular imaging significantly improved discrimination for multiterritorial disease (AUC 0.86-0.90) and subclinical atherosclerosis (AUC 0.96 for femoral plaque).
  • Carotid and aortic plaques showed greater incremental value for multiterritorial disease, while femoral plaque provided the most significant improvement for detecting any subclinical atherosclerosis.

Conclusions:

  • The incremental value of vascular imaging in PsA risk assessment is dependent on the vascular territory assessed and the outcome.
  • Femoral artery imaging offers the greatest benefit for identifying the presence of subclinical atherosclerosis.
  • Carotid and aortic imaging are more valuable for detecting multiterritorial vascular involvement, supporting a tailored, multiterritorial approach to CV risk assessment in PsA.

Keywords:
SCORE2cardiometabolic burdencardiovascular riskcarotid ultrasoundfemoral ultrasoundpsoriatic arthritissubclinical atherosclerosis

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