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Review
. 2013 Apr 4;2(2):e000062.
doi: 10.1161/JAHA.113.000062.

Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies

Ehrin J Armstrong  1 , Caitlin T Harskamp, April W Armstrong
Affiliations
Review

Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies

Ehrin J Armstrong et al. J Am Heart Assoc. .

Abstract

Background: Psoriasis is a chronic inflammatory disease that may be associated with increased risk of cardiovascular events, including cardiovascular mortality, myocardial infarction, and stroke.

Methods and results: We searched the MEDLINE, EMBASE, and Cochrane Central Register databases for relevant studies in English between January 1, 1980, and January 1, 2012. Extraction was by 3 independent reviewers. Summary incidence, risk ratios (RRs), and confidence intervals (CIs) were calculated using fixed-effects and random-effects modeling. Meta-regression was also performed to identify sources of between-study variation. Nine studies were included, representing a total of 201 239 patients with mild and 17 415 patients with severe psoriasis. The level of covariate adjustment varied among studies, leading to the possibility of residual confounding. Using the available adjusted effect sizes, mild psoriasis remained associated with a significantly increased risk of myocardial infarction (RR, 1.29; 95% CI, 1.02 to 1.63) and stroke (RR, 1.12; 95% CI, 1.08 to 1.16). Severe psoriasis was associated with a significantly increased risk of cardiovascular mortality (RR, 1.39; 95% CI, 1.11 to 1.74), myocardial infarction (RR, 1.70; 95% CI, 1.32 to 2.18), and stroke (RR, 1.56 95% CI, 1.32 to 1.84). Based on these risk ratios and the background population event rates, psoriasis is associated with an estimated excess of 11 500 (95% CI, 1169 to 24 407) major adverse cardiovascular events each year.

Conclusions: Mild and severe psoriasis are associated with an increased risk of myocardial infarction and stroke. Severe psoriasis is also associated with an increased risk of cardiovascular mortality. Future studies should include more complete covariate adjustment and characterization of psoriasis severity.

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Figures

Figure 1.
Figure 1.
Article selection. CV indicates cardiovascular; MACE, major adverse cardiovascular events.
Figure 2.
Figure 2.
Cardiovascular death among patients with psoriasis. A, Risk of cardiovascular death among patients with mild psoriasis. B, Risk of cardiovascular death among patients with severe psoriasis. Rates are reported as events/1000 person‐years.
Figure 3.
Figure 3.
Myocardial infarction among patients with psoriasis. A, Risk of myocardial infarction among patients with mild psoriasis. B, Risk of myocardial infarction among patients with severe psoriasis. Rates are reported as events/1000 person‐years.
Figure 4.
Figure 4.
Stroke among patients with psoriasis. A, Risk of stroke among patients with mild psoriasis. B, Risk of stroke among patients with severe psoriasis. Rates are reported as events/1000 person‐years.
See this image and copyright information in PMC

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