A recent study showed that the risk of cardiovascular (CV) events in patients with psoriatic disease rises with higher levels of two cardiac biomarkers in a manner independent of risk calculated by the Framingham Risk Score (FRS). However, researchers of this study described that neither of the two biomarkers identified in the study – cardiac troponin I (cTnI) and N-terminal pro-brain-type natriuretic peptide (NT-proBNP) – caused an improvement in predictive performance when integrated with the FRS, despite their association with carotid plaque burden.

Psoriasis and psoriatic arthritis are associated with a greater risk of CV morbidity and mortality, some what because of systemic inflammation that causes atherogenesis. Measures of CV risk like the FRS depend on traditional measures of CV risk and thus may underestimate the CV event risk of people with psoriatic disease, as described in the newer study, published online in Arthritis & Rheumatology. biomarker science advancement in psoriatic arthritis is needed for a variety of places of guidance, like choosing a medication more accurately for the patient, guiding clinicians regarding risk prediction for things like persistent, severe disease activity, progressive structural damage from disease, and predicting very common comorbidity that occurs in [psoriasis and] psoriatic arthritis patients.

These biomarkers could assist with patient counseling. Some patients may struggle with guidance to lose weight or adopt lifestyle measures to limit CV risk, and more accurate predictions of risk may serve as further motivation. 

Both cTnI and NT-proBNP have been linked to increased CV risk in the general population, but their utility in rheumatologic diseases is scarcely known.

The researchers analyzed data from 358 patients, with a mean follow-up of 3.69 years. After adjustment for CV risk factors, lipid-lowering therapy, and creatinine levels, an association was found between cTnI levels and total carotid plaque area, but not for levels of NT-proBNP. Atherosclerosis advanced in 89 participants, however, no significant relationship between progression and cTnI or NT-proBNP levels were found after multivariate adjustment.

Separately, the researchers also analyzed 1,000 individuals with psoriatic arthritis or with psoriasis and no arthritis, who were followed for a mean of 7.1 years. After adjustment for FRS, an association was described between the risk of a CV event and each 1–standard deviation increase in both cTnI and NT-proBNP.

The combination of both biomarkers with the FRS predicted a higher CV risk. Neither biomarker showed a significant difference in altering CV risk prediction when added individually to FRS, however, cTnI showed some significance.

Dr. Mease recommended evaluating calcium scores in coronary arteries as measured by CT instead of the carotid plaque burden. He further added that a registry-type study with hundreds of patients to identify whether or not adding troponin could be useful is needed.

SOURCE- Kling J. CV risk biomarkers tentatively identified in psoriatic disease. Dermatology News. 2022. https://www.mdedge.com/dermatology/article/252687/psoriatic-arthritis/cv-risk-biomarkers-tentatively-identified-psoriatic