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Background: Triglyceride Glucose Index (TyG) is a surrogate marker positively correlated with atherosclerotic burden in patients with psoriatic arthritis (PsA). Atherosclerotic index of plasma (AIP) levels have not been evaluated in patients with subclinical atherosclerosis and PsA.
Objectives: To compare levels the levels of AIP and TGI between PsA-patients with and without carotid plaque (CP).
Methods: Cross-sectional study that included PsA-patients aged 40 to 75 years old who fulfilled the 2006 Classification Criteria for PsA. Patients with previous cardiovascular disease (myocardial infarction, stroke, or peripheral artery disease) were excluded. Carotid ultrasound was performed on all study participants. The presence of carotid plaque (CP) was defined as diffuse carotid intima-media thickness (cIMT) ≥1.2 mm or focal thickness ≥0.5 mm. Cardiovascular disease risk was evaluated using the algorithm: FRS-Lipids. AIP was defined by Log (TG/HDL-C) mg/dL. TyG was defined by Log (Fasting triglyceride (mg/dl) x fasting glucose (mg/dl)/2. The distribution between groups was assessed with the Kolmogorov-Smirnov test. Comparisons with Chi-square or Fisher’s exact test and Student’s t-test or Mann Whitney’s U-test, accordingly. The correlation between the AIP, TyG, cIMT, and FRS-Lipids was assessed by Spearman’s correlation coefficient. A ROC curve analysis was performed, and each algorithm’s cutoff points were determined using the Youden index. The area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LR) were calculated. A value of p≤0.05 was considered statistically significant.
Results: A total of 88 patients with PsA were included, mostly women (n=46, 52.3%), the mean age was 53 ± 11.3, median disease duration of PsA was 5.0 (3.0-10.7) years. Median AIP was 0.44 (0.31-0.66) and TGI 3.8 (3.6-4.0) of all patients included. The most prevalent cardiovascular risk factor was dyslipidemia (n= 36, 41.4%). Patients with carotid plaque and PsA presented higher TyG compared to the group without carotid plaque (p=0.010). (Table 1). In a sub-analysis, TyG showed a sensitivity and specificity of 70% and 47%, respectively, with an AUC of 0.687 95% CI 0.554-0.820, and a PPV of 49% to identify CP, similar to cardiovascular risk algorithms such as FRS-Lipids (sensitivity of 69%, specificity of 53%, AUC 0.675, 95% CI 0.528-0.812, PPV 51%). AIP did not identify CP in PsA-patients: AUC 0.615 95% CI 0.476-0.754, p=0.107.
Conclusion: AIP is not elevated in patients with PsA and subclinical atherosclerosis. However, TyG levels are increased in PsA-patients and CP. In addition, the TyG index showed similar sensitivity and specificity to conventional CVR algorithms to identify PsA-patients with CP. Prospective studies are needed to evaluate the performance of these surrogate markers to predict CV events in these patients.
Demographic characteristics.
| Characteristics | PsA patients with CP
| PsA patients without CP
| p-value |
|---|---|---|---|
| Age, years, ± SD | 57.7 ± 9.8 | 54.9 ± 6.3 | 0.006 |
| Women, n (%) | 18 (50) | 28 (53.8) | NS |
| Diabetes, n (%) | 13 (37.1) | 6 (11.5) | 0.005 |
| Hypertension, n (%) | 17 (48.6) | 17 (32.7) | NS |
| Dyslipidemia, n (%) | 19 (54.3) | 17 (32.7) | 0.045 |
| Obesity, n (%) | 11 (31.4) | 22 (42.3) | NS |
| Active smoking, n (%) | 6 (17.6) | 12 (23.1) | NS |
| Time of evolution, years, median (IQR) | 7.5 (3.2-16.5) | 6.0 (3.5-8.0) | NS |
| DAS28-CRP, ± SD | 2.4 ± 1.3 | 2.4 ± 1.0 | NS |
| PASI, median (IQR) | 0.4 (0.0-4.0) | 0.4 (0.0-1.9) | NS |
| NAPSI, median (IQR) | 0.0 (0.0-17.0) | 0.0 (0.0-4.5) | NS |
| DAPSA, median (IQR) | 10.1 (4.6-24.8) | 13.3 (5.3-22.4) | NS |
| AIP, median (IQR) | 0.48 (0.35-0.78) | 0.35 (0.21-0.54) | NS |
| TGI, median (IQR) | 3.9 (3.7-4.3) | 3.7 (3.6-3.8) | 0.010 |
| cIMT, mm, median (IQR) | 1.0 (0.8-1.2) | 0.5 (0.5-0.6) | 0.000 |
PsA, psoriatic arthritis; CP, carotid plaque; SD, standard deviation; IQR, interquartile range; NS, no significative; DAS28-CRP, 28-joint Disease Activity Score based on C-reactive protein; PASI, psoriasis area severity index; NAPSI, nail psoriasis severity index; DAPSA, disease activity in psoriatic arthritis; AIP, atherogenic index of plasma; TGI, triglyceride-glucose index; cIMT, carotid intima-media thickness.
Scatterplots of the association between cardiovascular algorithm, cIMT, and index.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.