Hyperuricemia is independently associated with an increased risk of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) among patients with psoriatic arthritis (PsA), according to results from a retrospective study presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting.

To reach this conclusion, Ana B. Arevalo, MD, from the Icahn School of Medicine at Mount Sinai St Luke’s and Mount Sinai West in New York, New York, and colleagues evaluated data of 37,315 adults with PsA from the National Inpatient Sample. The researchers sought to detect the prevalence of cardiovascular conditions, including coronary artery disease (CAD), AF, and HFpEF, among patients with concomitant hyperuricemia or gout. The patients were age-matched with control participants.

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A total of 2165 patients with PsA had concomitant hyperuricemia or gout (5.80%). Of these, 57% were women. The mean age was 61 years.

Results showed that PsA with concomitant hyperuricemia or gout was associated with a higher rate of AF (17.8% vs 6.1%), CAD (35.1% vs 19.4%), and HFpEF (7.2% vs 3.1%) compared with PsA without hyperuricemia or gout.

After multivariate adjustment for risk factors, patients with PsA and hyperuricemia or gout appeared to have a higher risk of AF and HFpEF compared with patients who had normal uric acid levels.

No statistical difference in CAD was observed between the groups after multivariate adjustment for confounders.

The researchers noted that it remains to be seen whether a treat-to-target approach with normalization of uric acid among patients with PsA will improve cardiovascular outcomes.

“We believe that our findings merit further investigation and that this study adds weight to the hypothesis of [uric acid] as a potential risk factor for [cardiovascular disease],” the researchers concluded. “Prospective studies are needed to establish the role of serum uric acid level as a biomarker or predictor for [cardiovascular disease], including CAD, [AF], and HFpEF in patients with PsA.”

—Melinda Stevens

Reference:

Arevalo AB, Haddadin F, Contreras G, Murray S, Luo Y, Ali Y. Cardiovascular impact of hyperuricemia in patients with psoriatic arthritis [abstract 2439]. Arthritis Rheumatol. 2019;71(suppl 10). Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. https://acrabstracts.org/abstract/cardiovascular-impact-of-hyperuricemia-in-patients-with-psoriatic-arthritis/. Accessed November 4, 2019.