title: Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study.
abstract: OBJECTIVE
  We aimed to quantify the risk of major adverse cardiovascular events (MACE) among patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA) and psoriasis without known PsA compared with the general population after adjusting for traditional cardiovascular risk factors.
  
  
  METHODS
  A population-based longitudinal cohort study from 1994 to 2010 was performed in The Health Improvement Network (THIN), a primary care medical record database in the UK. Patients aged 18-89 years of age with PsA, RA or psoriasis were included. Up to 10 unexposed controls matched on practice and index date were selected for each patient with PsA. Outcomes included cardiovascular death, myocardial infarction, cerebrovascular accidents and the composite outcome (MACE). Cox proportional hazards models were used to calculate the HRs for each outcome adjusted for traditional risk factors. A priori, we hypothesised an interaction between disease status and disease-modifying antirheumatic drug (DMARD) use.
  
  
  RESULTS
  Patients with PsA (N=8706), RA (N=41 752), psoriasis (N=138 424) and unexposed controls (N=81 573) were identified. After adjustment for traditional risk factors, the risk of MACE was higher in patients with PsA not prescribed a DMARD (HR 1.24, 95% CI 1.03 to 1.49), patients with RA (No DMARD: HR 1.39, 95% CI 1.28 to 1.50, DMARD: HR 1.58, 95% CI 1.46 to 1.70), patients with psoriasis not prescribed a DMARD (HR 1.08, 95% CI 1.02 to 1.15) and patients with severe psoriasis (DMARD users: HR 1.42, 95% CI 1.17 to 1.73).
  
  
  CONCLUSIONS
  Cardiovascular risk should be addressed with all patients affected by psoriasis, PsA or RA.
authors.affiliation: Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ogdie
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: YiDing
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Haynes
authors.affiliation: University of Iceland, Reykjavik, Iceland.
authors.forename: Thorvardur Jon
authors.initials: TJ
authors.lastname: Love
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Maliha
authors.affiliation: Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Yihui
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Hennessy
authors.affiliation: Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Center for Therapeutic Effectiveness Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kimmel
authors.affiliation: Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, Center for Dermatoepidemiology and Translation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Hyon
authors.initials: H
authors.lastname: Choi
authors.affiliation: Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
authors.forename: Nehal N
authors.initials: NN
authors.lastname: Mehta
authors.affiliation: Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, Center for Dermatoepidemiology and Translation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000150:complications* / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents
keywords: Epidemiology; Outcomes research; Psoriatic Arthritis; Rheumatoid Arthritis