Table 5. Extended study characteristics table.

Characteristics of the 74 included studies grouped by biologic class, showing the range of study designs, populations, and cardiovascular outcomes assessed.

CV: cardiovascular, MACE: major adverse cardiovascular events, MI: myocardial infarction, HF: heart failure, PWV: pulse wave velocity, IMT: intima–media thickness, PET/CT: positron emission tomography/computed tomography, DAS28-CRP: Disease Activity Score based on 28-joint count and C-reactive protein, T2DM: type 2 diabetes mellitus, AD: atopic dermatitis, HS: hidradenitis suppurativa

Biologic class	Predominant dermatologic indication(s)	Main study designs represented	Typical sample size range	Typical follow-up	Cardiovascular outcomes reported	Evidence volume (qualitative)	Overall evidence profile
TNF-α inhibitors (adalimumab, etanercept, infliximab, others)	Psoriasis, psoriatic arthritis, HS	Population-based cohorts, RCTs, post-hoc analyses of phase III trials, and mechanistic vascular/biomarker studies	From small mechanistic cohorts (<50) to large registries (>10,000 patients)	6–24 months in mechanistic and phase IV trials; up to ≥10 years in registry cohorts	MACE (MI, stroke, CV death), heart failure, CRP and other inflammatory markers, arterial stiffness (PWV, augmentation index), carotid IMT	High (the largest and most mature dataset)	Evidence of cardioprotection in psoriasis (reduced MACE compared with methotrexate and phototherapy), consistent with improvements in CRP and vascular biomarkers; however, high-dose infliximab and etanercept are associated with worsening heart failure in patients with pre-existing moderate–severe HF.
IL-12/23 inhibitor (ustekinumab)	Psoriasis, psoriatic arthritis	Phase II–III RCTs, pooled safety analyses, nationwide registry cohorts, mechanistic PET/CT, and vascular function studies	Small mechanistic cohorts (~10–50 patients) to national registry datasets (>5,000 patients; >10,000 patient-years)	12–24 weeks in mechanistic and phase IV studies; several years in observational registry data	MACE, all-cause mortality, aortic vascular inflammation (PET/CT), coronary flow reserve, arterial stiffness indices, circulating cardiovascular protein panels	Moderate	Consistent cardiovascular safety with no excess MACE vs placebo or TNF-α inhibitors; mechanistic data show transient reductions in vascular inflammation and improvements in myocardial/vascular function, but no clear long-term MACE risk reduction is demonstrated.
IL-17 inhibitors (secukinumab, ixekizumab)	Psoriasis, psoriatic arthritis	Phase III RCTs (e.g., UNCOVER, ERASURE/FIXTURE, FUTURE, SPIRIT), pooled safety analyses, mechanistic PET/CT and FMD studies, adipose-tissue inflammation studies, case series (myocarditis)	Moderate to large RCTs (hundreds to a few thousand participants); small mechanistic cohorts	24–52 weeks in most trials; pooled safety follow-up up to ~5 years	MACE, CRP, DAS28-CRP, aortic vascular inflammation (PET/CT), FMD, adipose-tissue inflammation	Moderate/emerging	Overall, the cardiovascular profile appears neutral, with low and comparable MACE rates relative to placebo; modest or inconsistent reductions in CRP; limited or delayed effects on vascular function; and case series suggesting potential benefit in IL-17A-associated myocarditis; however, long-term outcome data are lacking.
IL-23 inhibitors (guselkumab, tildrakizumab, risankizumab)	Psoriasis, psoriatic arthritis, metabolic syndrome subgroups	Phase III RCTs (e.g., reSURFACE, VOYAGE, DISCOVER), post-hoc cardiometabolic analyses, and small prospective metabolic studies	RCT and post-hoc populations typically in the hundreds to low thousands; smaller targeted cohorts in high-risk patients	24–52 weeks in pivotal trials; some extension/safety datasets up to ~3 years	MACE (from pooled safety datasets), CRP, IL-6, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios, body weight, waist circumference, blood pressure, fasting glucose, lipid profile	Emerging	Short- to medium-term safety appears reassuring with low MACE rates and broadly neutral cardiovascular signal. Post hoc data suggest improvements in systemic inflammatory indices and, at higher doses and in metabolic syndrome subgroups, favourable changes in lipids and glycaemic parameters. A potential pharmacovigilance signal for cerebrovascular events with risankizumab warrants cautious interpretation pending long-term observational data.
IL-4/IL-13 inhibitor (dupilumab)	AD (with/without atopic comorbidities); background evidence in asthma and chronic rhinosinusitis with nasal polyposis	Large multinational cohort studies, phase III RCTs, small mechanistic PET/CT, and endothelial-barrier studies	Small mechanistic cohorts (~10–30 patients) to large administrative/cohort datasets (thousands of patients)	2–4 years in cohort studies; weeks to months in mechanistic and imaging studies	MACE, broader cardiometabolic safety endpoints, systemic and aortic inflammation (PET/CT), endothelial barrier function, and vascular leakage	Moderate/emerging	Available evidence indicates a favourable cardiometabolic safety profile, with no increased risk of MACE compared with conventional systemic therapies; recent cohort data suggest a reduced risk of hypertension, dyslipidaemia, T2DM, and obesity compared with methotrexate or cyclosporine. Mechanistic data demonstrate reduced systemic and vascular inflammation and improved endothelial barrier integrity, although confirmation in higher-risk populations with longer follow-up is needed.