Underdiagnosis and undertreatment of cardiovascular risk factors in patients with moderate to severe psoriasis - 14/06/12
Reprint requests: Nehal N. Mehta, MD, MSCE, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 6 Penn Tower, Philadelphia, PA 19104.Abstract |
Background |
Patients with psoriasis are known to have an increased number of cardiovascular (CV) risk factors and be at increased risk for CV events.
Objectives |
We sought to describe and characterize the underdiagnosis and undertreatment of CV risk factors in patients with moderate to severe psoriasis.
Methods |
Medical histories including diabetes, hypertension, and hyperlipidemia were obtained from 2899 patients in 3 phase III ustekinumab trials, a therapeutic anti-interleukin (IL)-12/IL-23p40 monoclonal antibody. Reported history was compared with measured fasting glucose, fasting lipids, and blood pressure. Ten-year Framingham risk scores and the proportion of patients achieving glycemic, lipid, and blood pressure targets were evaluated.
Results |
Significant risk factors existed in patients with moderate to severe psoriasis (58.6% and 28.8% of patients had ≥2 and ≥3 established CV risk factors, respectively). Based on Framingham risk score, 18.6% of patients were at high risk and 12.3% were at intermediate risk for CV events. At baseline, a small proportion of patients with diabetes (2.3%), hypertension (9.1%), or hyperlipidemia (4.9%) were previously without a diagnosis. However, 19.1%, 21.8%, and 38.6% of patients with diabetes, hypertension, or hyperlipidemia, respectively, were untreated at baseline, and the proportion at treatment goal was not ideal (hypertension 59.6% and hyperlipidemia 69.7%), especially for diabetes (36.7%).
Limitations |
Results are based on a clinical trial population and findings may not be generalizable to the general psoriasis population.
Conclusions |
In this moderate to severe psoriasis population, a high prevalence of undiagnosed and undertreated CV risk factors existed, emphasizing the importance of screening patients with psoriasis for CV risk factors.
Le texte complet de cet article est disponible en PDF.Key words : cardiovascular risk, diabetes, hyperlipidemia, hypertension, psoriasis, underdiagnosis, undertreatment, ustekinumab
Abbreviations used : ADA, ASCVD, BMI, CHD, CI, CRP, CV, DBP, FRS, HbA1c, HDL-C, IL, NCEP, RA, SBP
Plan
| Supported by Centocor Research and Development Inc. |
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| Disclosures: Dr Kimball was a consultant and investigator for Abbott, Amgen, Centocor, and Novartis; a consultant for Idera; and an investigator for Pfizer. Dr Mrowietz has received honoraria as a speaker and/or advisor, travel reimbursement, or educational grants from Abbott, Biogen-Idec, Celgene, Centocor, Forward Pharma, Janssen, Leo Pharma, MSD, and Wyeth/Pfizer. Dr Reich has received honoraria as a consultant and/or advisory board member and/or acted as paid speaker and/or contributed in clinical trials sponsored by Abbott, Basilea, Biogen-Idec, Celgene, Centocor, Essex Pharma, Forward Pharma, Janssen-Cilag, Leo Pharma, Novartis, Pfizer, Schering-Plough, UCB, and Wyeth. Dr Langley has received research grants, served on scientific advisory boards, and been a speaker for Amgen, Biogen-Idec, Centocor, Genentech, Novartis, Schering-Plough, and Serono. Ms You and Dr Hsu are employees of Centocor. Drs Szapary and Yeilding are employees of Centocor and own stock in Johnson & Johnson, of which Centocor is a fully owned subsidiary. Dr Rader has been a consultant for Johnson & Johnson. Dr Mehta has no conflicts of interest to declare. |
Vol 67 - N° 1
P. 76-85 - juillet 2012 Retour au numéro
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