title: The Framingham Risk Score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease.
abstract: OBJECTIVE
  To investigate the usefulness of carotid atherosclerosis assessment in cardiovascular risk stratification of patients with psoriatic disease compared with the Framingham Risk Score (FRS).
  
  
  METHODS
  Patients with psoriatic arthritis (PsA) and psoriasis alone (PsC), who had no previous history of cardiovascular disease, chronic kidney disease or diabetes mellitus were recruited. They underwent assessment of their cardiovascular risk factors and the FRS was calculated. Based on the FRS, the participants were classified into low, intermediate and high-risk categories. Ultrasound assessment of the carotid artery was performed, and carotid intima-media thickness (cIMT) and total plaque area (TPA) were measured. Patients were stratified into three ultrasound-based risk categories (low, intermediate and high) according to the severity of atherosclerosis. The extent of reclassification from FRS-based category into US-based risk category was assessed.
  
  
  RESULTS
  A total of 226 patients with psoriatic disease were assessed. FRS correlated moderately with TPA (r=0.36) and cIMT (r=0.37) and explained only 19% of their variability. 56.1% of the patients in the FRS-based low to intermediate risk groups were found to have carotid plaques. 55.9% of the patients from the FRS-based intermediate risk category were reclassified into an ultrasound-based high-risk category, while 47.1% of the patients in the FRS-based low-risk category were reclassified into a higher US-based risk group. The extent of reclassification into a higher risk category was particularly high among patients with PsA.
  
  
  CONCLUSIONS
  Ultrasound assessment of subclinical atherosclerosis may improve risk stratification of patients with psoriatic disease, particularly of those with PsA.
authors.affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Lihi
authors.initials: L
authors.lastname: Eder
authors.affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Vinod
authors.initials: V
authors.lastname: Chandran
authors.affiliation: Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000209:etiology; D011565:Psoriasis / Q000150:complications* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: Cardiovascular Disease; Psoriatic Arthritis; Ultrasonography