Excess cardiovascular morbidity in psoriatic arthritis and cardioprotective effects of biologic dmards: a propensity-matched analysis

To quantify the cardiovascular burden in patients with psoriatic arthritis (PsA) compared to matched controls, and to assess whether biologic disease-modifying antirheumatic drugs (bDMARDs) reduce cardiovascular risk in PsA. We conducted a retrospective cohort study using the TriNetX Global Health Research Network (2002-2025). Adults with PsA (N = 123,031) were 1:1 propensity-score matched to controls without PsA (N = 123,031) on demographics, comorbidities, and medications. Within the PsA cohort, bDMARD-treated patients (N = 44,870) were matched to conventional synthetic DMARD-treated patients (N = 44,870). Outcomes included major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction, stroke, heart failure, and cardiovascular procedures. Hazard ratios (HRs) were estimated using Cox models. Incidence rates per 1,000 person-years and E-values for unmeasured confounding were calculated. PsA patients had significantly higher cardiovascular morbidity than controls: MACE (HR 1.74; 62.9 vs. 36.4 per 1,000 person-years), mortality (HR 1.95; 60.2 vs. 31.0 per 1,000 person-years), heart failure (HR 1.96), myocardial infarction (HR 1.71), and stroke (HR 1.49). E-values ranged from 2.5 to 3.9, indicating robustness to unmeasured confounding. Among PsA patients, bDMARDs were associated with reduced MACE (HR 0.95) and mortality (HR 0.92,) compared to conventional synthetic DMARDs. PsA confers substantial excess cardiovascular risk comparable to other inflammatory arthropathies. Biologic DMARDs modestly reduce cardiovascular events, supporting their role in comprehensive PsA management. Systematic cardiovascular risk assessment should be integrated into routine PsA care.