Psoriasis and Vascular Disease—Risk Factors and Outcomes: A Systematic Review of the Literature
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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.
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.
MEDLINE, Embase, and Cochrane Collaborations from inception through October 2009. We reviewed bibliographies of retrieved articles for additional references.
Cross-sectional, cohort-based, case-control, and randomized controlled trials which involved patients with psoriasis.
Two investigators independently reviewed studies and resolved any discrepancies by consensus.
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.
The quality of evidence was limited by study heterogeneity and lack of large scale prospective studies with long-term follow-up.
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.
KEY WORDSpsoriasis cardiovascular disease alcohol risk factors cross-sectional studies cohort-based studies
Autoantibodies against oxidized LDL
Body Mass Index
Coronary Artery Disease
Common Carotid Arteries
Calcium Channel Blockers
Congestive Heart Failure
Cross-sectional Study Quality
Erythrocyte Sedimentation Rate
Flow Mediated Dilation
Gastroesophageal Reflux Disease
High Density Lipoprotein
Homeostasis Model Assessment of Insulin Resistance
Ischemic Heart Disease
Intima Media Thickness
Low Density Lipoprotein
Left Ventricular Hypertrophy
Narrow Band Ultraviolet B Therapy
National Psoriasis Foundation
National Health and Wellness Survey
Oral Glucose Tolerance Test
Plasminogen activator inhibitor-1
Psoriasis Area and Severity Index
Polycystic Ovary Syndrome
Physicians’ Global Assessment
Psoriasis Disability Index
Psoriasis Life Stress Inventory
Psoralen and Ultraviolet A Therapy
Peripheral Vascular Disease
Standard Mortality Ratio
Standard Prevalence Ratio
Total body surface area
Serum Total Homocysteine
Tumor Necrosis Factor
Tissue plasminogen activator
Drs Patel, Shelling, Prodanovich, Federman, and Kirsner had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Conflict of Interest
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