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

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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.

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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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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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Authors and Affiliations

  1. Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A, Miami, FL, 33136, USA

    Rita V. Patel MD, Michael L. Shelling MD, Srdjan Prodanovich MD & Robert S. Kirsner MD, PhD

  2. Department of Medicine, VA Connecticut Health Care, West Haven, CT, Yale University School of Medicine, New Haven, CT, USA

    Daniel G. Federman MD

  3. Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL, USA

    Robert S. Kirsner MD, PhD

Authors
  1. Rita V. Patel MD
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  2. Michael L. Shelling MD
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  3. Srdjan Prodanovich MD
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  4. Daniel G. Federman MD
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  5. Robert S. Kirsner MD, PhD
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Corresponding author

Correspondence to Robert S. Kirsner MD, PhD.

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Patel, R.V., Shelling, M.L., Prodanovich, S. et al. Psoriasis and Vascular Disease—Risk Factors and Outcomes: A Systematic Review of the Literature. J GEN INTERN MED 26, 1036–1049 (2011). https://doi.org/10.1007/s11606-011-1698-5

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  • DOI: https://doi.org/10.1007/s11606-011-1698-5

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