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1. If an experiment is conducted with 5 conditions and 6
subjects in each condition, what are dfn and dfe?
2. The following data are from a hypothetical study on the
effects of age and time on scores on a test of reading
comprehension. Compute the analysis of variance summary
table.
12-year olds
16-year olds
30 minutes
65
74
68
71
59
66
72
82
46
76
60 minutes
69
95
61
92
69
95
73
98
61
94
Please use this link to answer problems 3 and 4.
http://onlinestatbook.com/2/case_studies/adhd.html
3. (AT) The dataset ADHD Treatment has four scores per
subject.
a. Is the design between-subjects or within-subjects?
b. Create an ANOVA summary table.
4. (AT) Using the Anger Expression Index from the Angry
Moods study as the dependent variable, perform a 2x2 ANOVA
with gender and sports participation as the two factors. Do
athletes and non-athletes differ significantly in how much anger
they express? Do the genders differ significantly in Anger
Expression Index? Is the effect of sports participation
significantly different for the two genders?
13.2 The F Distribution and the F-Ratio
Use the following information to answer questions five and six.
Suppose a group is interested in determining whether teenagers
obtain their drivers licenses at approximately the same average
age across the country. Suppose that the following CHAPTER
13 | F DISTRIBUTION AND ONE-WAY ANOVA 719
http://openstaxcollege.org/files/textbook_version/hi_res_pdf/15/
col11562-op.pdf
Page 720.
Northeast
South
West
Central
East
16.3
16.9
16.4
16.2
17.1
16.1
16.5
16.5
16.6
17.2
16.4
16.4
16.6
16.5
16.6
16.5
16.2
16.1
16.4
16.8
¯
X=
________
________
________
________
________
________
________
________
________
________
5. degrees of freedom – numerator: df(num) = _________
6. F statistic = ________
7. A researcher wants to know if the mean times (in minutes)
that people watch their favorite news station are the same.
Suppose that Table 13.24 shows the results of a study.
8. Are the mean number of times a month a person eats out the
same for whites, blacks, Hispanics and Asians? Suppose that
Table 13.26 shows the results of a study.
White
Black
Hispanic
Asian
6
4
7
8
8
1
3
3
2
5
5
5
4
2
4
1
6
6
7
9. A grassroots group opposed to a proposed increase in the gas
tax claimed that the increase would hurt working-class people
the most, since they commute the farthest to work. Suppose that
the group randomly surveyed 24 individuals and asked them
their daily one-way commuting mileage. The results are as
follows.
Working Class
Professional (Middle Income
Professional (Wealthy)
17.8
16.5
8.5
26.7
17.4
6.3
49.4
22
4.6
9.4
7.4
12.6
65.4
9.4
11
47.1
2.1
28.6
19.5
6.4
15.4
51.2
13.9
9.3
10. Is the variance for the amount of money, in dollars, that
shoppers spend on Saturdays at the mall the same as the
variance for the amount of money that shoppers spend on
Sundays at the mall? Suppose that the Table 13.34 shows the
results of a study.
Saturday
Sunday
Saturday
Sunday
75
44
62
137
18
58
0
82
150
61
124
39
94
19
50
127
62
99
31
141
73
60
118
73
89
Mædica - a Journal of Clinical Medicine
ORIGIN AL PAPERSORIGIN AL PAPERS
19Maedica A Journal of Clinical Medicine, Volume 9 No.1
2014
MAEDICA – a Journal of Clinical Medicine
2014; 9(1): 19-24
Cardiovascular Risk in Psoriatic
Arthritis – A Cross-Sectional Study
Claudiu POPESCUa,b; Ana Maria PINTILIEb; Violeta
BOJINCAa,b;
Andra BALANESCUa,b; Ruxandra IONESCUa,b
a„Sfanta Maria” Clinical Hospital, Bucharest, Romania
bDepartment of Rheumatology and Internal Medicine, „Carol
Davila” University of
Medicine and Pharmacy, Bucharest, Romania
Address for correspondence:
Claudiu Popescu, „Sfânta Maria” Clinical Hospital, 37-39 Ion
Mihalache Boulevard, 011192, 1st District, Bucharest, Romania.
E-mail: [email protected]
Article received on the 20th of September 2013. Article
accepted on the 25th of February 2014.
ABSTRACT
Objectives: The present study aims to estimate long term
cardiovascular risk in psoriatic arthritis
(PsA) patients and to identify clinical and/or laboratory features
which influence this risk.
Materials and methods: cross-sectional design; sample: 103 in-
patients known with psoriatic ar-
thritis (PsA) and 56 normal age-matched female in-patients;
cardiovascular variables recorded: age,
gender, arterial hypertension (AHT), ischemic heart disease
(IHD), dyslipidemia (lipid profile), type II
diabetes mellitus (DM; fasting plasma glucose - FPG), obesity
(body mass index - BMI), smoking, car-
diovascular 10-year risk (SCORE high risk charts); PsA
variables recorded: age at onset, inflammation
markers; phenotype (peripheral/axial disease); type of
treatment.
Outcomes: The PsA group included 44 males and 59 females (p
= 0.167) with an average age of 52
years (23-80). SCORE was significantly correlated with age of
onset, BMI, triglycerides, FPG. Among
these patients, males, smokers, those with axial involvement,
with IHT, with AHT and those not treated
with glucocorticoids had a significantly higher SCORE. The
subgroup of 56 PsA women, age-matched
with 56 normal women, had a significantly higher SCORE, even
after controlling for covariates.
Conclusions: Cardiovascular risk of PsA patients estimated on
SCORE charts correlates with meta-
bolic clinical and laboratory features and is associated with
classical cardiovascular risk factors. The
axial involvement in PsA is associated with a higher
cardiovascular risk when compared to non-axial
PsA. Women with PsA have a higher cardiovascular risk than
normal women, which sustains the opin-
ion that PsA may be considered an independent cardiovascular
risk factor.
Keywords: psoriatic arthritis, cardiovascular risk, SCORE
INTRODUCTION
P
soriatic arthritis (PsA) is an auto-im-
mune chronic inflammatory disease
associated with psoriasis and the
lack of rheumatoid factor in most
patients (1). It has been classified as
a spondylarthritis (2), since it shares some clini-
cal elements with this nosological group, name-
ly sacroiliitis, dactylitis, enthesitis and uveitis.
Compared with the general population, PsA
patients have higher morbidity and mortality
rates (3,4) and a higher cardiovascular risk (5).
In fact, more than a third of PsA patients’ deaths
are caused by cardiovascular factors (3,6,7).
This excess in cardiovascular mortality can be
explained by the association of PsA with ath-
erosclerosis (8), as a recent meta-analysis also
CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS
20 Maedica
A Journal of Clinical Medicine, Volume 9 No.1 2014
demonstrates (9). Thus, compared to normal
individuals, PsA patients have a higher preva-
lence of ischemic heart disease (IHD),(3) arte-
rial hypertension (AHT) (3,10), angina and
myo cardial infarction (11), heart failure and
vas cular disease (9), obesity and metabolic syn-
drome (12), type II diabetes mellitus (DM) and
hyperglycemia (8,13,14), dyslipidemia (3,8)
and inflammation (8). It has been established
that PsA is equivalent to rheumatoid arthritis
and DM regarding its cardiovascular risk
(15,16). There are several tools used to esti-
mate long term cardiovascular risk, such as
SCORE charts (Systematic Coronary Risk Evalu-
ation), published by the European Society of
Cardiology (17). Good clinical practice requires
an approximation of PsA cardiovascular risk
since this disease can be considered an inde-
pendent cardiovascular risk factor (7), which
indicates an early detection and therapeutic
management of these patients (18,19). There is
insufficient and contradictory data regarding
the decrease of cardiovascular risk of PsA pa-
tients using disease modifying anti-rheumatic
drugs (DMARDs) (9). For example, some au-
thors observed that methotrexate does not de-
crease the risk of hospitalization for IHD (20)
cardio-protective in PsA patients (21). In this
context, the present study aims to estimate
long term cardiovascular risk in PsA patients
and to identify clinical and/or laboratory fea-
MATERIALS AND METHODS
The population sample was studied in a cross-sectional design
and it comprised two
groups of in-patients, randomly admitted to the
hospital from 2012 to 2013. The first group in-
cluded 103 patients known with PsA, who ful-
filled the disease classification criteria (CASPAR
2006) (22). The second group included 56 nor-
mal female patients, matched with an equal
number of PsA women by age, ethnicity and
geographical area. Each participant in the study
gave informed consent, and the study was ap-
proved by the local ethics committee.
AHT was defined as: systolic blood pres-
sure ≥140 mmHg or diastolic blood pressure
≥90 mmHg (mechanical sphygmomanometer;
5 mmHg error) or anti-hypertensive drug the-
rapy (23). IHD was defined if the patient had
suggestive electrocardiographic modifications
or a history of acute coronary syndromes, an-
gina, rhythm or conduction abnormalities,
ischemic heart failure (24). Dyslipidemia was
defined as triglycerides >150 mg/dL or total
cholesterol >200 mg/dL or treatment with
statins/fibrates (25). Type II DM was defined if
the patient had fasting plasma glucose level
(FPG) >126 mg/dL on two occasions or plasma
glucose level ≥200 on one occasion or treat-
ment with insulin/oral hypoglycemic drugs
(26). Obesity was defined by a body mass in-
dex (BMI) ≥30 kg/m2 (wall stadiometer, 0.5 cm
error; mechanical scale, 100 mg error). Cardio-
vascular risk was estimated using high risk
SCORE charts, adequate for the Romanian
population (17).
Normally distributed data were reported as
“mean (standard deviation; interval)”, while
non-normally distributed data were reported as
“median (interval)”. Differences were evaluat-
ed using non-
Fisher’s correction were appropriate) for nomi-
nal variables; Mann-Whitney U test for scale
variables. Spearman correlation coefficients
were computed. Since most variables were
non-normally distributed, linear regression and
parametric covariance analysis could not be
done. So, for testing the significance of SCORE
differences between normal and PsA patients
controlling for confounding variables (age, BMI
etc.) the following algorithm was used: SCORE
and its covariates were ranked; the ranks of
SCORE were linearly regressed on the ranks of
covariates, saving un-standardized residuals; a
one-way analysis of variance war run on these
residuals with the diagnostic grouping variable
(normal/PsA) (27). All tests were two-sided,
were considered significant if p ≤0.05 and
were computed using SPSS Statistics v.17.0.1
for Windows (SPSS Inc., Chicago, S.U.A.,
OUTCOMES
1. General characteristics. Table 1 summa-
rizes the general characteristics of the PsA
group. Overweight, hyperglycemia, dyslipid-
emia, inflammatory syndrome, peripheral di-
sease pattern, smoking and IHD predominated
in this group.
2. Cardiovascular risk. The SCORE value
correlated significantly with age (a variable in-
cluded in SCORE), age of PsA onset, triglycer-
ides, FPG and BMI (Table 2). On average, the
CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS
21Maedica A Journal of Clinical Medicine, Volume 9 No.1
2014
following subgroups had a significantly higher
SCORE compared to the respective subgroup:
men, smokers, patients with IHD and AHT, pa-
tients with axial PsA (Figure 1A) and patients
who did not receive glucocorticoids (GCs; see
Table 3). Compared to patients without anti-
-
ment had a significantly higher median disease
duration (120 months compared to 48 months,
p = 0.001) and a lower mean SCORE-estimat-
ed cardiovascular risk (1.35% compared to
2.52%, p = 0.077), which failed to reach statis-
tical significance in this group. There were no
significant differences between these two sub-
groups regarding the frequency of cardiovascu-
lar disease (p > 0.05).
3. Comparison of a PsA subgroup with nor-
mal individuals. The subgroup of 56 PsA wom-
en, age-matched with 56 normal women, had
significantly lower rates of AHT and dyslipid-
emia, but significantly higher inflammation
markers (Table 4). Compared to normal wom-
en, PsA had a significantly higher SCORE (Fig.
1B), even after controlling for the covariates
recorded by the study (smoking, DM, IHD,
AHT, dyslipidemia, cholesterol, triglycerides,
DISCUSSION
The present study reports a mean SCORE of 2.3% in 103 PsA
patients. The main cardio-
vascular risk factors observed had the following
prevalence in the PsA group: smoking: 23.3%
(24/103); type II DM: 11.6% (12/103); AHT:
42.7% (44/103); IHD: 22.3% (23/103); obesi-
ty: 34.9% (36/103); dyslipidemia: 33.9%
(35/103). The observed cardiovascular risk fac-
tors had a marked tendency to cluster. For
e xample, patients with AHT, compared with
non-AHT patients, had significantly higher age,
BMI, triglycerides, FPG and significantly higher
frequencies of obesity, type II DM and dyslipi-
demia (p <0.05). The same was true for any of
these variables.
FIGURE 1A. Distribution of SCORE values among PsA
subgroups
with axial disease (n = 46; average 2.9%) and without axial
disease (n
= 57; average 1.7%; p = 0.022). B. Distribution of SCORE
values in the
normal female group (n = 56; average 1.79%) compared to 56
PsA
female patients (average 3.02%; p = 0.010).
TABLE 1. PsA group’s general characteristics (n = 103).
* 32 patients (31.1%) were on statins; 12 patients (11.7%) were
on fibrates
PsA – psoriatic arthritis; PAD – peripheral (periph.) and axial
disease (dis.); NSAID – non-steroidal anti-
inflammatory drugs; GCs - glucocorticoids; DMARD – disease
modifying anti-rheumatic drugs; biologics –
blockers; DM – diabetes mellitus; AHT – arterial hypertension;
IHD – ischemic heart disease; BMI – body mass index;
TC – total cholesterol; TG – triglycerides; FPG – fasting plasma
glucose; ESR – erythrocyte sedimentation rate; CRP
- C-reactive protein; SBP – systolic blood pressure.
variable present absent p variable value
males 44 (42.7%) 59 (57.3%) 0.167 age (years) 52.3 (12.7; 23 -
80)
smokers 24 (23.3%) 79 (76.7%) < 0.001 age onset (years) 45.8
(14.1; 17 - 80)
periph. dis. 99 (96.1%) 4 (3.90%) < 0.001 dis. duration (mo) 53
(1 - 360)
axial dis. 46 (44.7%) 57 (55.3%) 0.324 BMI (kg/m2) 27.9 (5.6;
15.1 - 44.5)
PAD 42 (40.8%) 61 (59.2%) 0.076 TC (mg/dL) 198 (102 - 305)
NSAID 68 (66.1%) 35 (33.9%) 0.001 TG (mg/dL) 114 (37 -
677)
GCs 21 (20.4%) 81 (79.6%) < 0.001 FPG (mg/dL) 106.1 (40.6;
66 - 428)
DMARD 78 (75.7%) 25 (24.3%) < 0.001 ESR (mm/1h) 37.2 (2 -
124)
biologics 20 (19.4%) 83 (80.6%) < 0.001 CRP (mg/L) 9.43
(0.14 - 139.4)
type II DM 12 (11.6%) 92 (89.3%) < 0.001 SBP (mmHg) 130.6
(12; 110 - 150)
AHT 44 (42.7%) 59 (57.3%) 0.167 SCORE (%) 1 (0 - 12)
IHD 23 (22.3%) 80 (77.7%) < 0.001
obesity 36 (34.9%) 67 (65.1%) 0.003
dyslipidemia* 35 (33.9%) 68 (66.1%) < 0.001
statins 32 (31.1%) 71 (68.9%) < 0.001
CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS
22 Maedica
A Journal of Clinical Medicine, Volume 9 No.1 2014
The SEPHAR study data offer an adequate
comparison regarding the cardiovascular risk
and its factors, since this study was carried out
on a representative sample of the normal Ro-
manian population. Thus, the average cardio-
vascular risk of the SEPHAR sample, estimated
using the same high risk SCORE charts, was
3.5% (range: 0-35%) (28), higher than the aver-
age of our 103 PsA patients. This difference
probably originates from the type of patients
included in the two studies: most of the SEP-
HAR subjects were not on record for cardiovas-
cular risk factors and thus they did not benefit
from medical strategies aimed to reduce their
risk, while our PsA patients, due to the nature
of their chronic disease, were regularly reevalu-
ated by their physicians and were receiving ad-
equate medical therapies (blood pressure and
lipid lowering drugs, aspirin etc.) and lifestyle
modification advice. The prevalence of AHT
(42.7%) and smoking (23.3%) in our PsA group
did not differ significantly from the respective
frequencies in the SEPHAR sample (44.9%;
906/2017; p=0.661; respectively 27%;
545/2017; p=0.407) (28,29). Compared to
the data from the PRESENT study (another epi-
de miologic study conducted on a representa-
tive sample for the normal Romanian popula-
tion) (30), our PsA group had significantly lower
prevalence of type II DM (11.6% compared to
20%; 159/796; p=0.043) and dyslipidemia
(33.9% compared to 47%; 374/796; p=0.013),
and a significantly higher prevalence of IHD
(22.3% compared to 13%; 104/796; p=0.011),
with no significant differences in obesity preva-
lence (34.9% compared to 33%; 263/796;
p=0.698). The differences regarding the preva-
lence of DM and dyslipidemia can be ex-
plained by the fact that PRESENT investigators
recorded these diagnoses anamnestically, while
our study, besides anamnesis (which includes
questions regarding drug therapies) was de-
signed to objectively measure of FPG and lipid
profile.
It is interesting to note that SCORE corre-
lated in our PsA group with two elements of the
metabolic syndrome (FPG, BMI) (31,32), which
indicates a common physiopathological pro-
cess responsible for metabolic and cardiovas-
cular modifications. The fact that SCORE was
significantly higher in men, smokers, patients
with AHT and IHD from our sample strength-
ens this assertion.
Regarding the differences of SCORE be-
tween PsA subgroups, two aspects deserve dis-
cussion. The first aspect refers to the unusual
behavior of the PsA subgroup which was on
GCs at the time of inclusion in the study. The
expected therapeutic effect of GCs in PsA is
their anti-inflammatory function, but our GCs-
treated PsA patients had significantly higher
ESR than those not treated with GCs. Some of
the most important side effects of GCs are the
metabolic modifications (dyslipidemia, obesi-
ty), but our GCs-treated PsA patients had a sig-
nificantly lower average BMI and dyslipidemia
prevalence than those not receiving GCs. Al-
though they did not differ from any other point
of view, GCs-treated PsA patients had a signifi-
cantly lower SCORE than those not receiving
TABLE 2. Spearman correlations of SCORE with continuous
variables in the PsA groups (n = 103).
PsA – psoriatic arthritis; BMI – body mass index; TC – total
cholesterol; TG –
triglycerides; FPG – fasting plasma glucose; ESR – erythrocyte
sedimentation
rate; CRP – C-reactive protein; SBP – systolic blood pressure
SCORE SCORE
variable rho p variable rho p
age 0.815 < 0.001 BMI 0.239 0.015
age at onset 0.766 < 0.001 TC 0.118 0.235
disease duration - 0.137 0.168 TG 0.223 0.023
ESR 0.148 0.136 FPG 0.432 < 0.001
CRP 0.163 0.100 SBP 0.141 0.154
TABLE 3. Spearman correlations of SCORE with continuous
variables in the PsA groups (n = 103).
& SCORE percentages represent the mean of the certain PsA
subgroup
PsA – psoriatic arthritis; PAD – peripheral (periph.) and axial
disease (dis.);
NSAID – non-steroidal anti-inflammatory drugs; GCs –
glucocorticoids;
DMARD – disease modifying anti-rheumatic drugs; biologics –
blockers; DM – diabetes mellitus; AHT – arterial hypertension;
IHD –
ischemic heart disease.
subgroup p
SC
O
R
E
v
al
u
e
males (n = 44): 3.5% females (n = 59) 1.3% < 0.001
with periph. dis. (n = 99):
1.0%
without periph. dis. (n =
4): 3.0%
0.146
with axial dis. (n = 46):
2.9%
without axial dis. (n = 57):
1.7%
0.022
with PAD (n = 42): 2.8%
without PAD (n = 61):
1.9%
0.080
with NSAID (n = 68):
2.5%
without NSAID (n = 35):
2.2%
0.551
with GCs (n = 21): 1.5%
without GCs (n = 81):
2.5%
0.041
with DMARD (n = 78):
2.2%
without DMARD (n = 25):
2.6%
0.551
with biologics (n = 20):
1.4%
without biologics (n = 83):
2.5%
0.065
smokers (n = 24): 3.7% nonsmokers (n = 79): 1.9% 0.021
with AHT (n = 44): 3.6%
without AHT (n = 59):
1.4%
< 0.001
with IHD (n = 23): 3.7%
without IHT (n = 80):
1.8%
< 0.001
with DM (n = 11): 4.0% without DM (n = 92): 2.1% 0.064
obese (n = 36): 2.5% non-obese (n = 67): 2.2% 0.416
with dyslipidemia (n =
35): 2.6%
without dyslipidemia (n =
68): 2.1%
0.154
CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS
23Maedica A Journal of Clinical Medicine, Volume 9 No.1
2014
GCs. These observations point out either a
cardio-protective role of GCs either the prefer-
ence of rheumatologist to prescribe GC to pa-
tients with a better cardiovascular risk factor
profile and active disease. Testing these hy-
potheses requires a prospective study design,
which must record the duration and dose of
GCs therapy. The fact that anti-
patients had a significantly longer disease dura-
tion reflects the algorithm by which patients
end up receiving biologic drugs, in the sense
that their disease activity has to be insufficiently
controlled by DMARD therapy first. In spite of
this difference, knowing that a longer disease
duration is associated with a more adverse car-
diovascular profile, our PsA treated with bio-
logics tended to have a lower SCORE, which is
in accordance with the general view on cardio-
vascular risk reduction potential of biologics.
The second aspect refers to the cardiovas-
cular risk of PsA with axial involvement, which
was significantly higher in our group compared
with non-axial disease. There are many studies
which demonstrate on one hand that PsA pa-
tients have a higher cardiovascular risk than the
general population and on the other hand that
spondylarthritis is associated with such an ele-
vated risk (33,34), but to our knowledge, no
other author reported a higher cardiovascular
risk in PsA with axial involvement.
The limits of the study include: its cross-
sectional design, which did not allow following
the patients and recording their cardiovascular
events/diagnoses; the relatively small sample
size, which did not produce normally distrib-
uted variables; the lack of normal age-matched
male subjects (cardiovascular risk profiles in
men and women evolve quite differently so,
even in the availability of a normal male group,
the statistical analysis would have been more
appropriately done for each sex subgroup in-
dependently); the absence of such variables as
cholesterol fractions (HDL, LDL) and abdomi-
nal circumference, which would have allowed
CONCLUSIONS
Cardiovascular risk of PsA patients estimated on SCORE charts
correlates with metabolic
clinical and laboratory features (BMI, triglycer-
ides, FPG) and is associated with classical car-
diovascular risk factors (male gender, smoking,
IHD, AHT). These cardiovascular risk factors
have a strong tendency to aggregate in the
same patient. The axial involvement in PsA is
associated with a higher cardiovascular risk
when compared to non-axial PsA. Women
with PsA have a higher cardiovascular risk than
normal women, which sustains the opinion
that PsA may be considered an independent
cardiovascular risk factor. The cardiovascular
risk of PsA patients receiving classical DMARDs
was similar with that of PsA patients without
this treatment, but it was significantly lower in
PsA patients on GCs when compared to those
without GCs. Prospective studies are needed to
asses the true value of disease modifying thera-
py in PsA regarding cardiovascular risk reduc-
tion.
Conflicts of interests: none declared.
Financial support: none declared.
Acknowledgments: The authors would like
to thank the rheumatologists of “Sfanta Maria”
Clinical Hospital of Bucharest for providing pa-
tients.
TABLE 4. The comparison between a subgroup of PsA women
and
an age-matched normal women group.
* SCORE difference remains significant after controlling with
any of the listed
variables
PsA – psoriatic arthritis; DM – diabetes mellitus; AHT –
arterial hypertension;
IHD – ischemic heart disease; BMI – body mass index; TC –
total cholesterol;
TG – triglycerides; FPG – fasting plasma glucose; ESR –
erythrocyte
sedimentation rate; CRP – C-reactive protein
variable PsA (n = 56) normal (n = 56) p
female 56 (100%) 56 (100%) 0.000
smokers 17 (30.3%) 13 (23.2%) 0.393
type II DM 9 (16.1%) 10 (17.8%) 0.801
AHT 27 (48.2%) 39 (69.6%) 0.021
IHD 17 (30.6%) 17 (30.6%) 1,000
dyslipidemia 21 (37.05%) 34 (60.7%) 0.014
obesity 22 (39.3%) 17 (30.6%) 0.321
age (years) 56.89 (9.41) 56.95 (9.27) 0.968
BMI (kg/m2) 28.9 (5.9) 29.7 (5.2) 0.383
TC (mg/dL) 207 (125-302) 211 (132-333) 0.481
TG (mg/dL) 125.5 (54-667) 110 (43-843) 0.076
FPG (mg/dL) 99 (79-428) 104 (80-210) 0.238
ESR (mm/dL) 32.5 (2-112) 21 (5-133) 0.013
CRP (mg/L) 9.78 (1.3-139) 4 (0.1-155) < 0.001
CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS
24 Maedica
A Journal of Clinical Medicine, Volume 9 No.1 2014
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1. If an experiment is conducted with 5 conditions and 6 subjects .docx

  • 1. 1. If an experiment is conducted with 5 conditions and 6 subjects in each condition, what are dfn and dfe? 2. The following data are from a hypothetical study on the effects of age and time on scores on a test of reading comprehension. Compute the analysis of variance summary table. 12-year olds 16-year olds 30 minutes 65 74 68 71 59 66 72 82 46 76 60 minutes 69 95 61 92 69
  • 2. 95 73 98 61 94 Please use this link to answer problems 3 and 4. http://onlinestatbook.com/2/case_studies/adhd.html 3. (AT) The dataset ADHD Treatment has four scores per subject. a. Is the design between-subjects or within-subjects? b. Create an ANOVA summary table. 4. (AT) Using the Anger Expression Index from the Angry Moods study as the dependent variable, perform a 2x2 ANOVA with gender and sports participation as the two factors. Do athletes and non-athletes differ significantly in how much anger they express? Do the genders differ significantly in Anger Expression Index? Is the effect of sports participation significantly different for the two genders?
  • 3. 13.2 The F Distribution and the F-Ratio Use the following information to answer questions five and six. Suppose a group is interested in determining whether teenagers obtain their drivers licenses at approximately the same average age across the country. Suppose that the following CHAPTER 13 | F DISTRIBUTION AND ONE-WAY ANOVA 719 http://openstaxcollege.org/files/textbook_version/hi_res_pdf/15/ col11562-op.pdf Page 720. Northeast South West Central East 16.3 16.9 16.4 16.2 17.1 16.1 16.5 16.5 16.6 17.2 16.4 16.4 16.6 16.5 16.6 16.5
  • 4. 16.2 16.1 16.4 16.8 ¯ X= ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ 5. degrees of freedom – numerator: df(num) = _________ 6. F statistic = ________ 7. A researcher wants to know if the mean times (in minutes) that people watch their favorite news station are the same. Suppose that Table 13.24 shows the results of a study. 8. Are the mean number of times a month a person eats out the same for whites, blacks, Hispanics and Asians? Suppose that Table 13.26 shows the results of a study. White
  • 5. Black Hispanic Asian 6 4 7 8 8 1 3 3 2 5 5 5 4 2 4 1 6 6 7 9. A grassroots group opposed to a proposed increase in the gas tax claimed that the increase would hurt working-class people the most, since they commute the farthest to work. Suppose that the group randomly surveyed 24 individuals and asked them their daily one-way commuting mileage. The results are as follows. Working Class Professional (Middle Income Professional (Wealthy) 17.8 16.5
  • 6. 8.5 26.7 17.4 6.3 49.4 22 4.6 9.4 7.4 12.6 65.4 9.4 11 47.1 2.1 28.6 19.5 6.4 15.4 51.2 13.9 9.3 10. Is the variance for the amount of money, in dollars, that shoppers spend on Saturdays at the mall the same as the variance for the amount of money that shoppers spend on Sundays at the mall? Suppose that the Table 13.34 shows the results of a study. Saturday Sunday Saturday Sunday 75 44 62
  • 7. 137 18 58 0 82 150 61 124 39 94 19 50 127 62 99 31 141 73 60 118 73 89 Mædica - a Journal of Clinical Medicine ORIGIN AL PAPERSORIGIN AL PAPERS 19Maedica A Journal of Clinical Medicine, Volume 9 No.1 2014
  • 8. MAEDICA – a Journal of Clinical Medicine 2014; 9(1): 19-24 Cardiovascular Risk in Psoriatic Arthritis – A Cross-Sectional Study Claudiu POPESCUa,b; Ana Maria PINTILIEb; Violeta BOJINCAa,b; Andra BALANESCUa,b; Ruxandra IONESCUa,b a„Sfanta Maria” Clinical Hospital, Bucharest, Romania bDepartment of Rheumatology and Internal Medicine, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Address for correspondence: Claudiu Popescu, „Sfânta Maria” Clinical Hospital, 37-39 Ion Mihalache Boulevard, 011192, 1st District, Bucharest, Romania. E-mail: [email protected] Article received on the 20th of September 2013. Article accepted on the 25th of February 2014. ABSTRACT Objectives: The present study aims to estimate long term cardiovascular risk in psoriatic arthritis (PsA) patients and to identify clinical and/or laboratory features which influence this risk. Materials and methods: cross-sectional design; sample: 103 in- patients known with psoriatic ar- thritis (PsA) and 56 normal age-matched female in-patients; cardiovascular variables recorded: age, gender, arterial hypertension (AHT), ischemic heart disease (IHD), dyslipidemia (lipid profile), type II
  • 9. diabetes mellitus (DM; fasting plasma glucose - FPG), obesity (body mass index - BMI), smoking, car- diovascular 10-year risk (SCORE high risk charts); PsA variables recorded: age at onset, inflammation markers; phenotype (peripheral/axial disease); type of treatment. Outcomes: The PsA group included 44 males and 59 females (p = 0.167) with an average age of 52 years (23-80). SCORE was significantly correlated with age of onset, BMI, triglycerides, FPG. Among these patients, males, smokers, those with axial involvement, with IHT, with AHT and those not treated with glucocorticoids had a significantly higher SCORE. The subgroup of 56 PsA women, age-matched with 56 normal women, had a significantly higher SCORE, even after controlling for covariates. Conclusions: Cardiovascular risk of PsA patients estimated on SCORE charts correlates with meta- bolic clinical and laboratory features and is associated with classical cardiovascular risk factors. The axial involvement in PsA is associated with a higher cardiovascular risk when compared to non-axial PsA. Women with PsA have a higher cardiovascular risk than normal women, which sustains the opin- ion that PsA may be considered an independent cardiovascular risk factor. Keywords: psoriatic arthritis, cardiovascular risk, SCORE INTRODUCTION P soriatic arthritis (PsA) is an auto-im- mune chronic inflammatory disease
  • 10. associated with psoriasis and the lack of rheumatoid factor in most patients (1). It has been classified as a spondylarthritis (2), since it shares some clini- cal elements with this nosological group, name- ly sacroiliitis, dactylitis, enthesitis and uveitis. Compared with the general population, PsA patients have higher morbidity and mortality rates (3,4) and a higher cardiovascular risk (5). In fact, more than a third of PsA patients’ deaths are caused by cardiovascular factors (3,6,7). This excess in cardiovascular mortality can be explained by the association of PsA with ath- erosclerosis (8), as a recent meta-analysis also CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS 20 Maedica A Journal of Clinical Medicine, Volume 9 No.1 2014 demonstrates (9). Thus, compared to normal individuals, PsA patients have a higher preva- lence of ischemic heart disease (IHD),(3) arte- rial hypertension (AHT) (3,10), angina and myo cardial infarction (11), heart failure and vas cular disease (9), obesity and metabolic syn- drome (12), type II diabetes mellitus (DM) and hyperglycemia (8,13,14), dyslipidemia (3,8) and inflammation (8). It has been established that PsA is equivalent to rheumatoid arthritis
  • 11. and DM regarding its cardiovascular risk (15,16). There are several tools used to esti- mate long term cardiovascular risk, such as SCORE charts (Systematic Coronary Risk Evalu- ation), published by the European Society of Cardiology (17). Good clinical practice requires an approximation of PsA cardiovascular risk since this disease can be considered an inde- pendent cardiovascular risk factor (7), which indicates an early detection and therapeutic management of these patients (18,19). There is insufficient and contradictory data regarding the decrease of cardiovascular risk of PsA pa- tients using disease modifying anti-rheumatic drugs (DMARDs) (9). For example, some au- thors observed that methotrexate does not de- crease the risk of hospitalization for IHD (20) cardio-protective in PsA patients (21). In this context, the present study aims to estimate long term cardiovascular risk in PsA patients and to identify clinical and/or laboratory fea- MATERIALS AND METHODS The population sample was studied in a cross-sectional design and it comprised two groups of in-patients, randomly admitted to the hospital from 2012 to 2013. The first group in- cluded 103 patients known with PsA, who ful- filled the disease classification criteria (CASPAR 2006) (22). The second group included 56 nor- mal female patients, matched with an equal number of PsA women by age, ethnicity and geographical area. Each participant in the study
  • 12. gave informed consent, and the study was ap- proved by the local ethics committee. AHT was defined as: systolic blood pres- sure ≥140 mmHg or diastolic blood pressure ≥90 mmHg (mechanical sphygmomanometer; 5 mmHg error) or anti-hypertensive drug the- rapy (23). IHD was defined if the patient had suggestive electrocardiographic modifications or a history of acute coronary syndromes, an- gina, rhythm or conduction abnormalities, ischemic heart failure (24). Dyslipidemia was defined as triglycerides >150 mg/dL or total cholesterol >200 mg/dL or treatment with statins/fibrates (25). Type II DM was defined if the patient had fasting plasma glucose level (FPG) >126 mg/dL on two occasions or plasma glucose level ≥200 on one occasion or treat- ment with insulin/oral hypoglycemic drugs (26). Obesity was defined by a body mass in- dex (BMI) ≥30 kg/m2 (wall stadiometer, 0.5 cm error; mechanical scale, 100 mg error). Cardio- vascular risk was estimated using high risk SCORE charts, adequate for the Romanian population (17). Normally distributed data were reported as “mean (standard deviation; interval)”, while non-normally distributed data were reported as “median (interval)”. Differences were evaluat- ed using non- Fisher’s correction were appropriate) for nomi- nal variables; Mann-Whitney U test for scale variables. Spearman correlation coefficients were computed. Since most variables were
  • 13. non-normally distributed, linear regression and parametric covariance analysis could not be done. So, for testing the significance of SCORE differences between normal and PsA patients controlling for confounding variables (age, BMI etc.) the following algorithm was used: SCORE and its covariates were ranked; the ranks of SCORE were linearly regressed on the ranks of covariates, saving un-standardized residuals; a one-way analysis of variance war run on these residuals with the diagnostic grouping variable (normal/PsA) (27). All tests were two-sided, were considered significant if p ≤0.05 and were computed using SPSS Statistics v.17.0.1 for Windows (SPSS Inc., Chicago, S.U.A., OUTCOMES 1. General characteristics. Table 1 summa- rizes the general characteristics of the PsA group. Overweight, hyperglycemia, dyslipid- emia, inflammatory syndrome, peripheral di- sease pattern, smoking and IHD predominated in this group. 2. Cardiovascular risk. The SCORE value correlated significantly with age (a variable in- cluded in SCORE), age of PsA onset, triglycer- ides, FPG and BMI (Table 2). On average, the CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS 21Maedica A Journal of Clinical Medicine, Volume 9 No.1
  • 14. 2014 following subgroups had a significantly higher SCORE compared to the respective subgroup: men, smokers, patients with IHD and AHT, pa- tients with axial PsA (Figure 1A) and patients who did not receive glucocorticoids (GCs; see Table 3). Compared to patients without anti- - ment had a significantly higher median disease duration (120 months compared to 48 months, p = 0.001) and a lower mean SCORE-estimat- ed cardiovascular risk (1.35% compared to 2.52%, p = 0.077), which failed to reach statis- tical significance in this group. There were no significant differences between these two sub- groups regarding the frequency of cardiovascu- lar disease (p > 0.05). 3. Comparison of a PsA subgroup with nor- mal individuals. The subgroup of 56 PsA wom- en, age-matched with 56 normal women, had significantly lower rates of AHT and dyslipid- emia, but significantly higher inflammation markers (Table 4). Compared to normal wom- en, PsA had a significantly higher SCORE (Fig. 1B), even after controlling for the covariates recorded by the study (smoking, DM, IHD, AHT, dyslipidemia, cholesterol, triglycerides, DISCUSSION The present study reports a mean SCORE of 2.3% in 103 PsA patients. The main cardio- vascular risk factors observed had the following
  • 15. prevalence in the PsA group: smoking: 23.3% (24/103); type II DM: 11.6% (12/103); AHT: 42.7% (44/103); IHD: 22.3% (23/103); obesi- ty: 34.9% (36/103); dyslipidemia: 33.9% (35/103). The observed cardiovascular risk fac- tors had a marked tendency to cluster. For e xample, patients with AHT, compared with non-AHT patients, had significantly higher age, BMI, triglycerides, FPG and significantly higher frequencies of obesity, type II DM and dyslipi- demia (p <0.05). The same was true for any of these variables. FIGURE 1A. Distribution of SCORE values among PsA subgroups with axial disease (n = 46; average 2.9%) and without axial disease (n = 57; average 1.7%; p = 0.022). B. Distribution of SCORE values in the normal female group (n = 56; average 1.79%) compared to 56 PsA female patients (average 3.02%; p = 0.010). TABLE 1. PsA group’s general characteristics (n = 103). * 32 patients (31.1%) were on statins; 12 patients (11.7%) were on fibrates PsA – psoriatic arthritis; PAD – peripheral (periph.) and axial disease (dis.); NSAID – non-steroidal anti- inflammatory drugs; GCs - glucocorticoids; DMARD – disease modifying anti-rheumatic drugs; biologics – blockers; DM – diabetes mellitus; AHT – arterial hypertension; IHD – ischemic heart disease; BMI – body mass index; TC – total cholesterol; TG – triglycerides; FPG – fasting plasma glucose; ESR – erythrocyte sedimentation rate; CRP
  • 16. - C-reactive protein; SBP – systolic blood pressure. variable present absent p variable value males 44 (42.7%) 59 (57.3%) 0.167 age (years) 52.3 (12.7; 23 - 80) smokers 24 (23.3%) 79 (76.7%) < 0.001 age onset (years) 45.8 (14.1; 17 - 80) periph. dis. 99 (96.1%) 4 (3.90%) < 0.001 dis. duration (mo) 53 (1 - 360) axial dis. 46 (44.7%) 57 (55.3%) 0.324 BMI (kg/m2) 27.9 (5.6; 15.1 - 44.5) PAD 42 (40.8%) 61 (59.2%) 0.076 TC (mg/dL) 198 (102 - 305) NSAID 68 (66.1%) 35 (33.9%) 0.001 TG (mg/dL) 114 (37 - 677) GCs 21 (20.4%) 81 (79.6%) < 0.001 FPG (mg/dL) 106.1 (40.6; 66 - 428) DMARD 78 (75.7%) 25 (24.3%) < 0.001 ESR (mm/1h) 37.2 (2 - 124) biologics 20 (19.4%) 83 (80.6%) < 0.001 CRP (mg/L) 9.43 (0.14 - 139.4) type II DM 12 (11.6%) 92 (89.3%) < 0.001 SBP (mmHg) 130.6 (12; 110 - 150) AHT 44 (42.7%) 59 (57.3%) 0.167 SCORE (%) 1 (0 - 12) IHD 23 (22.3%) 80 (77.7%) < 0.001 obesity 36 (34.9%) 67 (65.1%) 0.003 dyslipidemia* 35 (33.9%) 68 (66.1%) < 0.001 statins 32 (31.1%) 71 (68.9%) < 0.001 CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS 22 Maedica
  • 17. A Journal of Clinical Medicine, Volume 9 No.1 2014 The SEPHAR study data offer an adequate comparison regarding the cardiovascular risk and its factors, since this study was carried out on a representative sample of the normal Ro- manian population. Thus, the average cardio- vascular risk of the SEPHAR sample, estimated using the same high risk SCORE charts, was 3.5% (range: 0-35%) (28), higher than the aver- age of our 103 PsA patients. This difference probably originates from the type of patients included in the two studies: most of the SEP- HAR subjects were not on record for cardiovas- cular risk factors and thus they did not benefit from medical strategies aimed to reduce their risk, while our PsA patients, due to the nature of their chronic disease, were regularly reevalu- ated by their physicians and were receiving ad- equate medical therapies (blood pressure and lipid lowering drugs, aspirin etc.) and lifestyle modification advice. The prevalence of AHT (42.7%) and smoking (23.3%) in our PsA group did not differ significantly from the respective frequencies in the SEPHAR sample (44.9%; 906/2017; p=0.661; respectively 27%; 545/2017; p=0.407) (28,29). Compared to the data from the PRESENT study (another epi- de miologic study conducted on a representa- tive sample for the normal Romanian popula- tion) (30), our PsA group had significantly lower prevalence of type II DM (11.6% compared to 20%; 159/796; p=0.043) and dyslipidemia (33.9% compared to 47%; 374/796; p=0.013), and a significantly higher prevalence of IHD
  • 18. (22.3% compared to 13%; 104/796; p=0.011), with no significant differences in obesity preva- lence (34.9% compared to 33%; 263/796; p=0.698). The differences regarding the preva- lence of DM and dyslipidemia can be ex- plained by the fact that PRESENT investigators recorded these diagnoses anamnestically, while our study, besides anamnesis (which includes questions regarding drug therapies) was de- signed to objectively measure of FPG and lipid profile. It is interesting to note that SCORE corre- lated in our PsA group with two elements of the metabolic syndrome (FPG, BMI) (31,32), which indicates a common physiopathological pro- cess responsible for metabolic and cardiovas- cular modifications. The fact that SCORE was significantly higher in men, smokers, patients with AHT and IHD from our sample strength- ens this assertion. Regarding the differences of SCORE be- tween PsA subgroups, two aspects deserve dis- cussion. The first aspect refers to the unusual behavior of the PsA subgroup which was on GCs at the time of inclusion in the study. The expected therapeutic effect of GCs in PsA is their anti-inflammatory function, but our GCs- treated PsA patients had significantly higher ESR than those not treated with GCs. Some of the most important side effects of GCs are the metabolic modifications (dyslipidemia, obesi- ty), but our GCs-treated PsA patients had a sig- nificantly lower average BMI and dyslipidemia prevalence than those not receiving GCs. Al-
  • 19. though they did not differ from any other point of view, GCs-treated PsA patients had a signifi- cantly lower SCORE than those not receiving TABLE 2. Spearman correlations of SCORE with continuous variables in the PsA groups (n = 103). PsA – psoriatic arthritis; BMI – body mass index; TC – total cholesterol; TG – triglycerides; FPG – fasting plasma glucose; ESR – erythrocyte sedimentation rate; CRP – C-reactive protein; SBP – systolic blood pressure SCORE SCORE variable rho p variable rho p age 0.815 < 0.001 BMI 0.239 0.015 age at onset 0.766 < 0.001 TC 0.118 0.235 disease duration - 0.137 0.168 TG 0.223 0.023 ESR 0.148 0.136 FPG 0.432 < 0.001 CRP 0.163 0.100 SBP 0.141 0.154 TABLE 3. Spearman correlations of SCORE with continuous variables in the PsA groups (n = 103). & SCORE percentages represent the mean of the certain PsA subgroup PsA – psoriatic arthritis; PAD – peripheral (periph.) and axial disease (dis.); NSAID – non-steroidal anti-inflammatory drugs; GCs – glucocorticoids; DMARD – disease modifying anti-rheumatic drugs; biologics – blockers; DM – diabetes mellitus; AHT – arterial hypertension; IHD – ischemic heart disease.
  • 20. subgroup p SC O R E v al u e males (n = 44): 3.5% females (n = 59) 1.3% < 0.001 with periph. dis. (n = 99): 1.0% without periph. dis. (n = 4): 3.0% 0.146 with axial dis. (n = 46): 2.9% without axial dis. (n = 57): 1.7% 0.022 with PAD (n = 42): 2.8% without PAD (n = 61): 1.9% 0.080
  • 21. with NSAID (n = 68): 2.5% without NSAID (n = 35): 2.2% 0.551 with GCs (n = 21): 1.5% without GCs (n = 81): 2.5% 0.041 with DMARD (n = 78): 2.2% without DMARD (n = 25): 2.6% 0.551 with biologics (n = 20): 1.4% without biologics (n = 83): 2.5% 0.065 smokers (n = 24): 3.7% nonsmokers (n = 79): 1.9% 0.021 with AHT (n = 44): 3.6% without AHT (n = 59):
  • 22. 1.4% < 0.001 with IHD (n = 23): 3.7% without IHT (n = 80): 1.8% < 0.001 with DM (n = 11): 4.0% without DM (n = 92): 2.1% 0.064 obese (n = 36): 2.5% non-obese (n = 67): 2.2% 0.416 with dyslipidemia (n = 35): 2.6% without dyslipidemia (n = 68): 2.1% 0.154 CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS 23Maedica A Journal of Clinical Medicine, Volume 9 No.1 2014 GCs. These observations point out either a cardio-protective role of GCs either the prefer- ence of rheumatologist to prescribe GC to pa- tients with a better cardiovascular risk factor profile and active disease. Testing these hy- potheses requires a prospective study design, which must record the duration and dose of GCs therapy. The fact that anti- patients had a significantly longer disease dura-
  • 23. tion reflects the algorithm by which patients end up receiving biologic drugs, in the sense that their disease activity has to be insufficiently controlled by DMARD therapy first. In spite of this difference, knowing that a longer disease duration is associated with a more adverse car- diovascular profile, our PsA treated with bio- logics tended to have a lower SCORE, which is in accordance with the general view on cardio- vascular risk reduction potential of biologics. The second aspect refers to the cardiovas- cular risk of PsA with axial involvement, which was significantly higher in our group compared with non-axial disease. There are many studies which demonstrate on one hand that PsA pa- tients have a higher cardiovascular risk than the general population and on the other hand that spondylarthritis is associated with such an ele- vated risk (33,34), but to our knowledge, no other author reported a higher cardiovascular risk in PsA with axial involvement. The limits of the study include: its cross- sectional design, which did not allow following the patients and recording their cardiovascular events/diagnoses; the relatively small sample size, which did not produce normally distrib- uted variables; the lack of normal age-matched male subjects (cardiovascular risk profiles in men and women evolve quite differently so, even in the availability of a normal male group, the statistical analysis would have been more appropriately done for each sex subgroup in- dependently); the absence of such variables as cholesterol fractions (HDL, LDL) and abdomi-
  • 24. nal circumference, which would have allowed CONCLUSIONS Cardiovascular risk of PsA patients estimated on SCORE charts correlates with metabolic clinical and laboratory features (BMI, triglycer- ides, FPG) and is associated with classical car- diovascular risk factors (male gender, smoking, IHD, AHT). These cardiovascular risk factors have a strong tendency to aggregate in the same patient. The axial involvement in PsA is associated with a higher cardiovascular risk when compared to non-axial PsA. Women with PsA have a higher cardiovascular risk than normal women, which sustains the opinion that PsA may be considered an independent cardiovascular risk factor. The cardiovascular risk of PsA patients receiving classical DMARDs was similar with that of PsA patients without this treatment, but it was significantly lower in PsA patients on GCs when compared to those without GCs. Prospective studies are needed to asses the true value of disease modifying thera- py in PsA regarding cardiovascular risk reduc- tion. Conflicts of interests: none declared. Financial support: none declared. Acknowledgments: The authors would like to thank the rheumatologists of “Sfanta Maria” Clinical Hospital of Bucharest for providing pa- tients.
  • 25. TABLE 4. The comparison between a subgroup of PsA women and an age-matched normal women group. * SCORE difference remains significant after controlling with any of the listed variables PsA – psoriatic arthritis; DM – diabetes mellitus; AHT – arterial hypertension; IHD – ischemic heart disease; BMI – body mass index; TC – total cholesterol; TG – triglycerides; FPG – fasting plasma glucose; ESR – erythrocyte sedimentation rate; CRP – C-reactive protein variable PsA (n = 56) normal (n = 56) p female 56 (100%) 56 (100%) 0.000 smokers 17 (30.3%) 13 (23.2%) 0.393 type II DM 9 (16.1%) 10 (17.8%) 0.801 AHT 27 (48.2%) 39 (69.6%) 0.021 IHD 17 (30.6%) 17 (30.6%) 1,000 dyslipidemia 21 (37.05%) 34 (60.7%) 0.014 obesity 22 (39.3%) 17 (30.6%) 0.321 age (years) 56.89 (9.41) 56.95 (9.27) 0.968 BMI (kg/m2) 28.9 (5.9) 29.7 (5.2) 0.383 TC (mg/dL) 207 (125-302) 211 (132-333) 0.481 TG (mg/dL) 125.5 (54-667) 110 (43-843) 0.076 FPG (mg/dL) 99 (79-428) 104 (80-210) 0.238 ESR (mm/dL) 32.5 (2-112) 21 (5-133) 0.013 CRP (mg/L) 9.78 (1.3-139) 4 (0.1-155) < 0.001 CARDIOVASCULAR RISK IN PSORIATIC ARTHRITIS 24 Maedica
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