Derivation and Internal Validation of a Disease‐Specific Cardiovascular Risk Prediction Model for Patients With Psoriatic Arthritis and Psoriasis

Author:

Colaco Keith12,Lee Ker‐Ai3,Akhtari Shadi12,Winer Raz4,Chandran Vinod25ORCID,Harvey Paula12,Cook Richard J.3,Piguet Vincent12,Gladman Dafna D.25ORCID,Eder Lihi12ORCID

Affiliation:

1. Women's College Research Institute Women's College Hospital Toronto Ontario Canada

2. Womens College Hospital and Department of Medicine University of Toronto Toronto Ontario Canada

3. University of Waterloo Waterloo Ontario Canada

4. Rambam Health Care Campus Haifa Israel

5. Schroeder Arthritis Institute University Health Network and Depertament of Medicine, University of Toronto Toronto Ontario Canada

Abstract

ObjectiveTo address suboptimal cardiovascular risk prediction in patients with psoriatic disease (PsD), we developed and internally validated a five‐year disease‐specific cardiovascular risk prediction model.MethodsWe analyzed data from a prospective cohort of participants with PsD without a history of cardiovascular events. Traditional cardiovascular risk factors and PsD‐related measures of disease activity were considered as potential predictors. The study outcome included nonfatal and fatal cardiovascular events. A base prediction model included 10 traditional cardiovascular risk factors. Eight PsD‐related factors were assessed by adding them to the base model to create expanded models, which were controlled for PsD therapies. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression with 10‐fold cross‐validation. Model performance was assessed using measures of discrimination and calibration and measures of sensitivity and specificity.ResultsBetween 1992 and 2020, 85 of 1,336 participants developed cardiovascular events. Discrimination of the base model (with traditional cardiovascular risk factors alone) was excellent, with an area under the receiver operator characteristic curve (AUC) of 85.5 (95% confidence interval [CI] 81.9–89.1). Optimal models did not select any of the tested disease‐specific factors. In a sensitivity analysis, which excluded lipid lowering and antihypertensive treatments, the number of damaged joints was selected in the expanded model. However, this model did not improve risk discrimination compared to the base model (AUC 85.5, 95% CI 82.0–89.1).ConclusionTraditional cardiovascular risk factors alone are effective in predicting cardiovascular risk in patients with PsD. A risk score based on these factors performed well, indicating excellent discrimination and calibration. image

Funder

Canadian Institutes of Health Research

Arthritis Society

Krembil Foundation

WCRI

National Psoriasis Foundation

Pfizer

Publisher

Wiley

Subject

Immunology,Rheumatology,Immunology and Allergy

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