IJCS | Volume 33, Nº2, March / April 2020

113 Campos et al. Psoriatic arthritis and cardiovascular risk Int J Cardiovasc Sci. 2020; 33(2):112-118 Original Article onychodystrophy. Sensitivity and specificity of this method are 99.7% and 99.1%, respectively. 15 Inflammatory rheumatologic diseases are associated with high mortality, largely due to cardiovascular causes. It may be justified by an increase in inflammatory cytokines, atherosclerosis, endothelial dysfunction, individual genetics, use of medications with a negative effect on the cardiovascular system, in addition to traditional risk factors. 16 Psoriasis is related to increased risk of acute myocardial infarction (AMI), especially in severe cases. 17-20 However, unlike other inflammatory diseases, these patients are more often obese. The pathophysiology of psoriasis and obesity involves many common cytokines that contribute to the components of metabolic syndrome: hypertension, dyslipidemia and insulin resistance. 14,18 In addition to the presence of comorbidities that act as a cardiovascular risk (CVR) factor, many studies detected increased rates of cardiovascular disease in this group. 19,21,22 Only one in every seven patients with psoriasis is aware of the atherosclerotic disease and metabolic syndrome risk they present. 23 Characterization of an association between PsA and increased CVRwould justify automatic reclassification of patients with this condition in high CVR, without the need for scores that could attribute different risk. Objectives To quantify cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) and to measure risk by the Global Cardiovascular Risk Score in patients with psoriatic arthritis. Methods Cross-sectional study carried out between September 2016 and June 2017 at the Rheumatology outpatient clinic of Hospital Universitário Lauro Wanderley (HULW), Jo o Pessoa - PB. Population and sample Study population consisted of all PsA patients followed at the rheumatology outpatient clinic of a reference hospital. Sample was chosen for convenience and a non-probabilistic stratified sample was adopted, due to the low prevalence of the disease. Inclusion criteria The study included patients classified according to the CASPAR criteria 24 (evaluated by a rheumatologist); aged between 30 and 74 years, since the Global Cardiovascular Risk Score (GCRS) used is restricted to individuals of this age group. 25 After adequate information, the patients signed the informed consent form (ICF). Exclusion criteria Patients with clinically manifest heart failure or atherosclerotic cardiovascular disease (coronary, cerebrovascular or peripheral occlusive disease) were excluded, until assessment, since the score used estimates the risk of onset and does not apply to patients with manifested cardiovascular disease. 25 Individuals diagnosed with another chronic inflammatory disease, other than PsA, were also eliminated. Instruments for data collection The CASPAR 24 criteria were used to confirm PsA classification/diagnosis; sociodemographic and clinical questionnaire based on the Framingham score 25 was used for global CVR; and a specific calculator was used for risk assessment, available on the online platform of the Framingham Heart Study; in addition to medical records data. Procedures for data collection This study was approved by the Research Ethics Committee of HULW - Jo o Pessoa, PB - under protocol number 56336216.1.0000.5183. Psoriatic arthritis patients underwent an interview and clinical examination for data collection and risk stratification according to the Framingham score 25 for global CVR. The most recent data of laboratory results were usedwith a maximumdelay of six months between testing and evaluation. This score considers the following: age, High Density Lipoprotein Cholesterol (HDL-C), total cholesterol, untreated systolic blood pressure (SBP) or treated SBP, smoking and diabetes. Age, condition of hypertension, smoking and diabetes are self-reported by the research participant, while HDL-C, total cholesterol, triglycerides, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were obtained from the medical record.