Journal of General Internal Medicine

, Volume 26, Issue 9, pp 1036–1049 | Cite as

Psoriasis and Vascular Disease—Risk Factors and Outcomes: A Systematic Review of the Literature

  • Rita V. Patel
  • Michael L. Shelling
  • Srdjan Prodanovich
  • Daniel G. Federman
  • Robert S. KirsnerEmail author



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.

Data Sources

MEDLINE, Embase, and Cochrane Collaborations from inception through October 2009. We reviewed bibliographies of retrieved articles for additional references.

Study Selection

Cross-sectional, cohort-based, case-control, and randomized controlled trials which involved patients with psoriasis.

Data Extraction

Two investigators independently reviewed studies and resolved any discrepancies by consensus.

Data Synthesis

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.


psoriasis cardiovascular disease alcohol risk factors cross-sectional studies cohort-based studies 



Autoantibodies against oxidized LDL


Body Mass Index


Blood Pressure


Coronary Artery Disease


Common Carotid Arteries


Calcium Channel Blockers


Congestive Heart Failure


Confidence Interval


C-Reactive Protein


Cross-sectional Study Quality


Cardiovascular Disease


Diabetes Mellitus


Erythrocyte Sedimentation Rate




Flow Mediated Dilation


Gastroesophageal Reflux Disease


High Density Lipoprotein


Homeostasis Model Assessment of Insulin Resistance


Hazard Ratio






Ischemic Heart Disease


Intima Media Thickness


Low Density Lipoprotein


Lipoprotein A


Left Ventricle


Left Ventricular Hypertrophy


Metabolic Syndrome


Myocardial Infarction




Narrow Band Ultraviolet B Therapy


Newcastle–Ottawa Score


National Psoriasis Foundation


National Health and Wellness Survey


Oral Glucose Tolerance Test


Odds Ratio




Plasminogen activator inhibitor-1


Psoriasis Area and Severity Index


Polycystic Ovary Syndrome


Physicians’ Global Assessment


Psoriasis Disability Index


Psoriasis Life Stress Inventory


Palmoplantar Pustulosis


Prevalence Ratio


Psoriatic Arthritis




Psoralen and Ultraviolet A Therapy


Psoriasis Vulgaris


Peripheral Vascular Disease


Risk Factor


Standard Mortality Ratio


Standard Prevalence Ratio


Total body surface area


Serum Total Homocysteine




Tumor Necrosis Factor


Tissue plasminogen activator








Author Contributions

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

None disclosed.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Rita V. Patel
    • 1
  • Michael L. Shelling
    • 1
  • Srdjan Prodanovich
    • 1
  • Daniel G. Federman
    • 2
  • Robert S. Kirsner
    • 1
    • 3
    Email author
  1. 1.Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Medicine, VA Connecticut Health Care, West Haven, CTYale University School of MedicineNew HavenUSA
  3. 3.Department of Epidemiology and Public HealthUniversity of Miami Miller School of MedicineMiamiUSA

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