title: Psoriasis and vascular disease-risk factors and outcomes: a systematic review of the literature.
abstract: BACKGROUND
  Psoriasis afflicts 2-3% of the world's population. Affected patients commonly have risk factors for cardiovascular disease (CVD). In addition, psoriasis is independently associated with CVD and mortality.
  
  
  OBJECTIVE
  To determine which CVD risk factors are associated with psoriasis independent of confounders, whether psoriasis is associated with CVD independent of CVD risk factors, and whether there is increased mortality among patients with psoriasis.
  
  
  METHODS
  MEDLINE, Embase, and Cochrane Collaborations from inception through October 2009. We reviewed bibliographies of retrieved articles for additional references.
  
  
  METHODS
  Cross-sectional, cohort-based, case-control, and randomized controlled trials which involved patients with psoriasis.
  
  
  METHODS
  Two investigators independently reviewed studies and resolved any discrepancies by consensus.
  
  
  RESULTS
  Of the 2,303 articles identified by literature search, 90 studies met inclusion criteria for this review; 15 were cohort-based studies, 45 were case-control, and 30 were cross-sectional.
  
  
  CONCLUSIONS
  The quality of evidence was limited by study heterogeneity and lack of large scale prospective studies with long-term follow-up.
  
  
  CONCLUSIONS
  Patients with psoriasis demonstrate a higher prevalence of cardiovascular risk factors and appear to be at increased risk for ischemic heart disease, cerebrovascular disease, and peripheral arterial disease. This increase in vascular disease may be independent of shared risk factors and may contribute to the increase in all-cause mortality. Future research should aim to more confidently distinguish between a true causal relationship or merely an association resulting from multiple shared risk factors. Physicians should screen for and aggressively treat modifiable risk factors for CVD in patients with psoriasis.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, Miami, FL 33136, USA.
authors.forename: Rita V
authors.initials: RV
authors.lastname: Patel
authors.forename: Michael L
authors.initials: ML
authors.lastname: Shelling
authors.forename: Srdjan
authors.initials: S
authors.lastname: Prodanovich
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Federman
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D006801:Humans; D011446:Prospective Studies; D011565:Psoriasis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*