Cardiovascular morbidity and mortality are elevated across all RMD. Algorithms for risk prediction are leaned on recommendations for the general population. Thus, current risk scores mostly neglect disease-related factors. In fact, preventive recommendations largely focus on lipid-lowering agents , often disregarding the role of disease-specific medication. Although several studies have pointed out the impact of nontraditional risk factors on RMD, to date no research group has looked at comparative disease-specific disparities in this regard.
To our knowledge, this is the first study to highlight commonalities and differences in cardiovascular risk profiles of patients with PsA, AAV, and SLE, offering a rationale with not only theoretical but also foremost practical relevance for a disease-specific CVD risk stratification.
In this cross-sectional observational study, we compared disparities in risk burden between cohorts of PsA (n=90), AAV (n=25), and SLE (n=23) patients.
Our data analysis revealed a significantly higher proportion of traditional risk factors in PsA subjects, whereas nontraditional cardiovascular risk markers were more often in the SLE and AAV cohorts. Nonetheless, implementing the SCORE2 algorithm did not reveal significant differences in risk stratification. Still, the younger mean age and the higher prevalence of females in the SLE cohort contributed to overall better outcomes in the SCORE2 results (Table 2). Considering that the disease duration might serve as a surrogate marker for the inflammatory exposure, it should be emphasized that SLE subjects had the longest disease duration of all. CRP and ESR levels, however, did not differ notably between the disease groups.
Interestingly, while odds ratios for cardiovascular events were comparable between PsA, AAV and SLE patients, there were differences in left ventricular function. AAV subjects had a substantially increased odds ratio for diastolic dysfunction, whereas SLE subjects had an elevated odds ratio for systolic dysfunction compared to PsA. However, consideration of traditional risk factors alone, could not predict these differences.
Overall, our findings in PsA are consistent with previous results showing increased prevalence and incidence of traditional cardiovascular risk factors . Nonetheless, data on nontraditional factors are limited although its contribution to CVD risk burden is acknowledged in various studies .
Together, the presented findings confirm that current algorithms for risk prediction fail to capture the complexity of underlying pathological mechanisms in RMD-related CVD risk.
Pointing out disease-specific disparities in CVD risk profiles may help us to understand pathophysiological processes leading to these differences and consequently provide the groundwork for future therapeutic strategies.
As a lack of time is a crucial factor in patient care and risk-assessment , our study also contributes to a more targeted and thus less time-consuming approach.
Limitations of this study include the cross-sectional study design, which prevents further investigation of causality and thus limits predictive conclusions.
Moreover, the findings regarding the higher proportion of diastolic dysfunction in the AAV group should be interpreted with caution as this might be due to elevated prevalence in patients with impaired renal function. Overall, limitations in representative value due to small sample sizes and thereupon limitations in regional and socioeconomic variability have to be considered.
As a side note, the mean BMI was over 25 kg/m2 across all patient groups. Although no significant differences were detected between PsA, AAV and SLE, a low-grade inflammation due to overweight has to be taken into consideration .