title: Incidence of cardiovascular disease in individuals with psoriasis: a systematic review and meta-analysis.
abstract: The relationship between psoriasis and increased risk of cardiovascular disease (CVD) is controversial. We critically evaluate 14 cohorts and meta-analyze the magnitude of CVD risk for the primary outcomes of CVD mortality, stroke, and myocardial infarction (MI), and establish subgroup risk for different psoriasis severities and age groups. Increased CVD risk was identified only in individuals with severe psoriasis (defined as requiring systemic therapy or hospital admission): the risk ratio relative to the general population was 1.37 (95% confidence interval (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. The relative risks of CVD were highest in the younger, severe psoriasis population (e.g., 3.10 (95% CI 1.98-4.86) for MI at 30 years), and absolute risks were greatest in older individuals with severe psoriasis (e.g., 23.2 excess MIs per 10,000 person-years at 60 years). Uncertainty remains about whether CVD risk is directly attributable to psoriasis, as the majority of studies failed to adequately adjust for key traditional risk factors.
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians of London, London, UK.
authors.forename: Eleanor J
authors.initials: EJ
authors.lastname: Samarasekera
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians of London, London, UK.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Neilson
authors.affiliation: Dermatology Centre, The University of Manchester, Manchester Academic Health Sciences Centre, Salford Royal Foundation Trust, Manchester, UK.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Warren
authors.affiliation: National Clinical Guideline Centre, Royal College of Physicians of London, London, UK.
authors.forename: Jill
authors.initials: J
authors.lastname: Parnham
authors.affiliation: St John's Institute of Dermatology, Division of Medicine and Molecular Genetics, Guy's Hospital, London, UK. Electronic address: catherine.smith@kcl.ac.uk.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Smith
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D011565:Psoriasis / Q000453:epidemiology* / Q000401:mortality*; D012307:Risk Factors