TABLE 1.
A synopsis of systematic reviews and meta-analyses investigating the association of psoriasis with conventional cardiovascular risk factors and adverse cardiovascular events.
| References | Type of study | Cardiovascular comorbidities | Study population | Key findings |
| Kaiser et al. (12) | Systematic review and meta-analysis | CAD | 14 eligible studies: 1,427 patients with psoriasis and 9,670 controls | Patients with psoriasis (RR = 1.14, 95% CI: 1.04–1.26; p = 0.004). For more severe CAD (CCS > 100) the risk was further increased (RR = 1.71, 95% CI: 1.28–2.30; p < 0.001) |
| Dhana et al. (11) | Systematic review and meta-analysis | Cardiovascular mortality | 12 eligible studies: 5 studies including 285,675 psoriasis patients, 3 studies including 188,223 patients with mild psoriasis and 4 studies including 17,317 patients with severe psoriasis | Pooled RR = 1.15 (95% CI: 1.09–1.21, I2 = 65.9%, P = 0.02) in patients with psoriasis. Pooled RR = 1.05 (95% CI: 0.92–1.20, I2 = 90.3%, P < 0.001) for mild psoriasis. Pooled RR = 1.38 (95% CI: 1.09–1.74, I2 = 91.0%, P < 0.001) for severe psoriasis |
| Raaby et al. (10) | Systematic review and meta-analysis | Stroke MI |
13 high-quality observational studies | Risk of stroke (HR = 1.10, 95% CI: 1.0–1.19) and risk of MI (HR = 1.20, 95% CI: 1.06–1.35), in patients with mild psoriasis. The risks of both stroke (HR = 1.38, 95% CI: 1.20–1.60), MI (HR = 1.70, 95% CI: 1.18–2.43) and cardiovascular death (HR = 1.37, 95% CI: 1.13–1.67) were increased in patients with severe psoriasis |
| Pietrzak et al. (22) | Review and meta-analysis | Cardiovascular events | Four case–control and 10 cohort studies. | Elevated risk for CV events in psoriasis patients compared with non-psoriasis controls (OR = 1.28; 95% CI: 1.18–1.38) |
| Armstrong et al. (97) | Systematic review and meta-analysis | Stroke MI |
Nine eligible studies were included representing a total of 201.239 patients with mild and 17.415 patients with severe psoriasis | Risk of MI (RR = 1.29; 95% CI: 1.02–1.63) and stroke (RR = 1.12; 95% CI: 1.08–1.16) in mild psoriasis. Significantly increased risk of cardiovascular mortality (RR = 1.39; 95% CI: 1.11–1.74), MI (RR = 1.70; 95% CI: 1.32–2.18), and stroke (RR = 1.56 95% CI: 1.32–1.84) in severe psoriasis |
| Samarasekera et al. (98) | Systematic review and meta-analysis | Cardiovascular Disease MI Stroke |
Of the 14 included studies, 10 were population-based cohorts, and sample sizes in the psoriasis group ranged from 462 to 130.976 | RR relative to the general population was 1.37 (95% CI: 1.17–1.60) for CVD mortality, 3.04 (95% CI: 0.65–14.35) for MI, and 1.59 (95% CI: 1.34–1.89) for stroke |
| Miller et al. (8) | Meta-analysis | Cardiovascular disease Ischemic heart disease Vascular disease Atherosclerosis Cerebrovascular disease Cardiovascular mortality Diabetes Hypertension Dyslipidemia Obesity Metabolic syndrome |
75 studies including up to 503.686 cases and 29.686.694 controls | Cardiovascular disease in total (OR = 1.4; 95% CI: 1.2–1.7), ischemic heart disease (OR = 1.5; 95% CI: 1.2–1.9), peripheral vascular disease (OR = 1.5; 95% CI: 1.2–1.8), and atherosclerosis (OR = 1.1; 95% CI: 1.1–1.2), cerebrovascular disease (OR = 1.1; 95% CI: 0.9–1.3) and cardiovascular mortality (OR = 0.9; 95% CI: 0.4–2.2). Diabetes (OR = 1.9 95% CI: 1.5–2.5), hypertension (OR = 1.8 95% CI: 1.6–2.0), dyslipidemia (OR = 1.5 95% CI: 1.4–1.7), obesity by body mass index (OR = 1.8 95% CI: 1.4–2.2), obesity by abdominal fat (OR = 1.6; 95% CI: 1.2–2.3), and the metabolic syndrome (OR = 1.8; 95% CI: 1.2–2.8) |
| Miller et al. (99) | Meta-analysis | Total cholesterol LDL Triglyceride Systolic blood pressure Diastolic blood pressure BMI Waist circumference Fasting glucose Non-fasting glucose HbA1c |
59 studies with up to 18.666 cases and 50.724 controls | Psoriasis cases had a higher total cholesterol WMD = 8.83 mg dL–1, 95% CI: 2.94–14.72, P = 0.003. Higher LDL WMD = 9.90 mg dL–1, 95% CI: 1.56–18.20, P = 0.020. Higher triglyceride WMD = 16.32 mg dL–1, 95% CI: 12.02–20.63, P < 0.001. Higher systolic blood pressure (WMD = 4.77 mmHg, 95% CI: 1.62–7.92, P = 0.003). Higher diastolic blood pressure (WMD = 2.99 mmHg, 95% CI: 0.60–5.38, P = 0.014). Higher BMI (WMD = 0.73 kg m–2, 95% CI: 0.37–1.09, P < 0.001). Higher waist circumference (WMD = 3.61 cm, 95% CI: 2.12–5.10, P < 0.001). Higher fasting glucose (WMD = 3.52 mg dL–1, 95% CI: 0.64–6.41, P = 0.017). Higher non-fasting glucose (11.70 mg dL–1, 95% CI: 11.24–12.15, P < 0.001) (=0.65 mmol L–1 and a Higher HbA1c 1.09 mmol mol–1, 95% CI: 0.87–1.31, P < 0.001) |
| Gaeta et al. (100) | Meta-regression analysis | MI Vascular disease Overall mortality Overall Cardiovascular Risk |
13 studies. 1.684.032 person-year became available in the psoriasis group and 43.146.770 person-year in the control group | Patients with psoriasis showed an increase of the overall cardiovascular risk compared to the control group (RR = 1.24 [CI: 1.18–1.31]; P < 0.00001). Significantly higher risk of infarction (RR = 1.24 [1.11–1.39]; P < 0.00001), vascular disease (RR = 1.27 [1.12–1.43]; P < 0.00001) and overall mortality (RR = 1.41 [0.97–2.04]; P < 0.00001) |
| Gu et al. (101) | Meta-analysis | Stroke MI Cardiovascular disease Coronary heart disease Peripheral vascular disease Cardiovascular mortality |
15 cohort studies | Risk of stroke (RR = 1.26; 95% CI: 1.12–1.41; p < 0.0001). Risk of MI (RR = 1.32; 95% CI: 1.13–1.55; p = 0.001). Cardiovascular disease (RR = 1.47; 95% CI: 1.30–1.6; p = 0.0001). Combined RRs = 1.39 (95% CI: 1.03–1.86; p = 0.03) for coronary heart disease, 1.55 (95% CI: 1.02–2.34; p = 0.04) for peripheral vascular disease, and 1.33 (95% CI: 1.00–1.77; p = 0.05) for cardiovascular mortality |
| Xu and Zhang (102) | Meta-analysis | Stroke MI |
Seven cohort studies | Psoriasis significantly increases the risk of stroke (RR = 1.21; 95% CI: 1.04–1.4) and MI (RR = 1.22; 95% CI: 1.05–1.42) separately. Substantial evidence of heterogeneity was also observed in both subgroup analyses (P < 0.001, I2 = 86.8% and P < 0.001, I2 = 83.1%). |
BMI, body mass index; CAD, coronary artery disease; CCS, coronary calcium score; CI, confidence intervals; LDL, low density lipoprotein; MI, myocardial infarction; OR, odds ratio; RR, rate ratio; WMD, weighted mean difference.