Cardiac troponins and NT-proBNP levels associated with CVD risk in psoriasis

Cardiovascular (CV) risk prediction in patients with psoriasis and psoriatic arthritis (PsA), collectively known as psoriatic disease (PsD), is of utmost importance as these patients are prone to dramatically increased risk of cardiovascular (CV) morbidity and mortality compared to the general population.

In a recent study aimed at determining whether cardiac troponin I (cTnI) and N-terminal pro-brain-type natriuretic peptide (NT-proBNP) can improve this risk stratification, authors Colaco et al have found that cTnI may reflect the burden of atherosclerosis, independent of traditional CV risk factors. Also, cTnI and NT-proBNP are associated with incident CV events independent of the Framingham risk score (FRS). These findings were recently published in the Arthritis and Rheumatology Journal.

It is not clear how much incremental information is gained by using novel markers like cTnI and NTproBNP in CV risk stratification or their association with carotid atherosclerosis in patients with PsD. They evaluated the association between cTnI and NT-proBNP and carotid atherosclerosis presence and progression.

Among 1,000 patients with PsD, carotid total plaque area (TPA) was measured in 358 participants at baseline. The association between cardiac biomarkers and carotid atherosclerosis was assessed by multivariable regression after adjusting for CV risk factors.

The study found that:

1. cTnI, and not NT-proBNP, was associated with TPA after adjusting for established CV risk factors.

2. Elevated cTnI and NT-proBNP were associated with a higher risk of developing future CV events independent of traditional CV risk factors,

3. The associations were stronger in males compared to females and the addition of cTnI or NT-proBNP did not improve the performance of the FRS for predicting CV events in psoriatic patients.

These findings suggest that increased atherosclerotic plaque burden is associated with subclinical cardiac injury which is associated with elevated concentrations of cardiac biomarkers.

This is the first study to investigate cTnI and NT-proBNP and their relationship with non-invasive measures of carotid atherosclerosis and clinical CV events in a large longitudinal cohort of patients with PsD.

"cTnI may be as effective as established measures of carotid plaque burden for identifying subclinical atherosclerosis long before CV events occur", note the authors.

However, the lack of improvement in prediction metrics beyond the FRS does not support the routine use of these cardiac biomarkers for CV risk stratification in asymptomatic patients with PsD.

Source: Arthritis and Rheumatology Journal. https://doi.org/10.1002/art.42079