Abstract 868: Prevalence, Underdiagnosis, and Undertreatment of Cardiovascular Risk Factors in Patients With Moderate-to-Severe Psoriasis
Objective: Psoriasis is associated with increased risk of CV disease. We characterized traditional CV risk factors, and assessed potential underdiagnosis and undertreatment of CV comorbidities in 2 899 moderate-to-severe psoriasis patients.
Methods: Baseline medical histories, including diabetes (DM), hypertension (HTN), and hyperlipidemia (HLP), were obtained from the Phase 3 program for ustekinumab, a monoclonal antibody to IL-12/23. Traditional CV risk factors were defined per the National Cholesterol Education Program (NCEP) guidelines, and Framingham Risk Score (FRS) was calculated. High CV risk was defined as either: established atherosclerotic cardiovascular disease (ASCVD), DM or 10yr FRS >20%. Intermediate CV risk was defined as 10yr risk ≥10 –20%. To assess the extent of underdiagnosis of comorbidities, baseline blood pressures (BP) and fasting glucose and lipids were compared to reported rates. To assess undertreatment, rates of patients with DM and HbA1C <7.0%, HTN and a BP <140/90 mmHg and high risk coronary heart disease equivalent patients with LDL <100 mg/dl were reported.
Results: The overall proportion of patients at high CV risk was 18.6%, with an additional 19.9% of patients at intermediate CV risk. The proportion of patients with ≥2 and ≥3 traditional CV risk factors was 58.6% and 28.8%, respectively. The mean HDL was 37.1±14.6 mg/dl in men (61.0%, HDL <40 mg/dl) and 42.1±17.0 mg/dl in women (68.4%, HDL<50 mg/dl). Baseline rates of DM, HTN and HLP were reported in 10.5%, 27.9% and 20.7% of patients, respectively. The relative rates of undiagnosed DM were 18%, HTN 25%, and HLP 19%. Compared to published guidelines, patients with DM, HTN and HLP were generally undertreated. Among all patients with DM, 38.4% were at a goal HbA1C. For HTN, 44.9% of patients were normotensive. For HLP, 50.9% of high risk patients were at LDL goal <100 mg/dl.
Conclusions: Per NCEP guidelines, approximately a third of moderate-to-severe psoriasis patients were at high or intermediate CV risk. Among those with DM, HTN or HLP, approximately 20% were undiagnosed for one of these comorbidities and most did not meet treatment goals. Appropriate CV risk factor screening, referral, and treatment in psoriasis patients are necessary to reduce the burden of CVD.