Journal of General Internal Medicine

, Volume 26, Issue 9, pp 1036–1049

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. Kirsner
Reviews

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.

Purpose

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.

Limitations

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.

KEY WORDS

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

Abbreviations

AuAb-oxLDL

Autoantibodies against oxidized LDL

BMI

Body Mass Index

BP

Blood Pressure

CAD

Coronary Artery Disease

CCA

Common Carotid Arteries

CCB

Calcium Channel Blockers

CHF

Congestive Heart Failure

CI

Confidence Interval

CRP

C-Reactive Protein

CSQ

Cross-sectional Study Quality

CVD

Cardiovascular Disease

DM

Diabetes Mellitus

ESR

Erythrocyte Sedimentation Rate

EtOH

Alcohol

FMD

Flow Mediated Dilation

GERD

Gastroesophageal Reflux Disease

HDL

High Density Lipoprotein

HOMA

Homeostasis Model Assessment of Insulin Resistance

HR

Hazard Ratio

Ht

Height

HTN

Hypertension

IHD

Ischemic Heart Disease

IMT

Intima Media Thickness

LDL

Low Density Lipoprotein

Lp(a)

Lipoprotein A

LV

Left Ventricle

LVH

Left Ventricular Hypertrophy

MBS

Metabolic Syndrome

MI

Myocardial Infarction

MTX

Methotrexate

NBUVB

Narrow Band Ultraviolet B Therapy

N-O

Newcastle–Ottawa Score

NPF

National Psoriasis Foundation

NWHS

National Health and Wellness Survey

OGTT

Oral Glucose Tolerance Test

OR

Odds Ratio

Outpt

Outpatient

PAI

Plasminogen activator inhibitor-1

PASI

Psoriasis Area and Severity Index

PCOS

Polycystic Ovary Syndrome

PGA

Physicians’ Global Assessment

PDI

Psoriasis Disability Index

PLSI

Psoriasis Life Stress Inventory

PPP

Palmoplantar Pustulosis

PR

Prevalence Ratio

PsA

Psoriatic Arthritis

Pt

Patient

PUVA

Psoralen and Ultraviolet A Therapy

PV

Psoriasis Vulgaris

PVD

Peripheral Vascular Disease

RF

Risk Factor

SMR

Standard Mortality Ratio

SPR

Standard Prevalence Ratio

TBSA

Total body surface area

tcHy

Serum Total Homocysteine

TG

Triglycerides

TNF

Tumor Necrosis Factor

tPA

Tissue plasminogen activator

Tx

Treatment

Wt

Weight

XS

Excess

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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
  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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