title: Subclinical cardiovascular disease in plaque psoriasis: association or causal link?
abstract: BACKGROUND
  Psoriasis patients have a high prevalence of cardiovascular events and are thought to have a relative risk increase of 25% as compared to the general population. However, a causal relationship between psoriasis and cardiovascular disease has not been established. We sought to perform a systematic review of existing data regarding the presence of endothelial dysfunction and subclinical atherosclerosis in patients with plaque psoriasis.
  
  
  METHODS
  A systematic literature search was performed, using Medline database and Ovid SP for relevant literature up to November 2012. Twelve studies met inclusion criteria from an initial search result of 529 articles.
  
  
  RESULTS
  Among the twelve studies meeting inclusion criteria, two (17%) reported increased mean coronary artery calcification (CAC) in psoriatic patients. Six studies (50%) showed carotid intima-media thickness [CIMT] increase in psoriasis. Five studies (42%) examined flow mediated dilation [FMD], of which three showed decreased FMD in psoriasis patients. One study (8%) each demonstrated a decreased coronary flow reserve and increased arterial stiffness as assessed by pulse wave velocity.
  
  
  CONCLUSIONS
  Patients with psoriasis have an increased burden of subclinical atherosclerosis and endothelial dysfunction. Patients with greater severity and/or disease duration should be targeted for primary screening for cardiovascular disease risk reduction.
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Shaharyar
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Haider
authors.initials: H
authors.lastname: Warraich
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: McEvoy
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Oni
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA.
authors.forename: Shozab S
authors.initials: SS
authors.lastname: Ali
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA.
authors.forename: Adil
authors.initials: A
authors.lastname: Karim
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Jamal
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Baptist Hospital of Miami and Baptist Cardiac & Vascular Institute, Miami, FL, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fialkow
authors.affiliation: Baptist Hospital of Miami and Baptist Cardiac & Vascular Institute, Miami, FL, USA; Department of Radiology, Florida International University, Miami, FL, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cury
authors.affiliation: Los Angeles Biomedical Research Institute, UCLA Harbor Medical Center, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Agatston
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Baptist Hospital of Miami and Baptist Cardiac & Vascular Institute, Miami, FL, USA; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA. Electronic address: KhurramN@baptisthealth.net.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D050197:Atherosclerosis / Q000150:complications*; D002114:Calcinosis / Q000473:pathology; D002318:Cardiovascular Diseases / Q000150:complications*; D002339:Carotid Arteries / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D015897:Comorbidity; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology; D006801:Humans; D007249:Inflammation; D011565:Psoriasis / Q000150:complications*; D012306:Risk; D059289:Vascular Stiffness
keywords: Atherosclerosis; Carotid intima–media thickness; Coronary artery calcium; Primary prevention; Psoriasis; Sub-endothelial dysfunction