P86 Are symptoms of cardiac ischaemia different in patients who have psoriasis than in those who do not?

Abstract

Abstract Patients with psoriasis have an increased risk of cardiovascular disease (CVD) for reasons that remain unknown. However, it may result from a complex interplay of contributory factors, including lifestyle and shared pathological mechanisms, as seen with other immune-mediated inflammatory diseases (IMIDs). Furthermore, in addition to epicardial coronary artery disease, patients with IMIDs have high levels of coronary microvascular dysfunction, which also contribute to cardiovascular morbidity and mortality. Our objective was to investigate whether the presentation of CVD may be different and therefore unrecognized in patients with psoriasis vs. those who do not have psoriasis. Sixty-six individuals with psoriasis and 112 age- and sex-matched individuals without psoriasis were recruited from the Chest Pain Clinic at a Regional Heart Care Centre. Traditional risk factors for CVD (smoking, body mass index, type 2 diabetes, blood pressure and lipid profile) were comparable between groups. Patients with psoriasis were statistically significantly older (P < 0.04) and more likely to have a family history of premature CVD (P < 0.01) than those without psoriasis. Individuals with psoriasis described poorly localized (P < 0.02), aching-type chest pain (P < 0.04) that radiated to the back (P < 0.01). The psoriasis group was significantly less likely to be investigated for coronary microvascular dysfunction with myocardial perfusion scanning (P < 0.002). However, 67% of patients with psoriasis were found to have flow-limiting disease (vs. 60% without psoriasis), classified as severe in 50% (vs. 43% without psoriasis), and were four times more likely to have two-vessel coronary disease, although this did not reach statistical significance. Individuals with both skin and joint psoriasis were more likely to have flow-limiting epicardial disease (14%) than those without arthropathy (10%; not significant). In conclusion, patients with psoriasis exhibit key differences in their presentation to heart care services than those who do not have psoriasis. Further research to individualize risk stratification for CVD in individuals with psoriasis is important.