Incidence of cardiovascular disease in individuals with psoriasis: A systematic review and meta-analysis

TY - JOUR

T1 - Incidence of cardiovascular disease in individuals with psoriasis

T2 - A systematic review and meta-analysis

AU - Samarasekera, Eleanor J

AU - Neilson, Julie M

AU - Warren, Richard B

AU - Parnham, Jill

AU - Smith, Catherine H

PY - 2013/10

Y1 - 2013/10

N2 - The relationship between psoriasis and increased risk of cardiovascular disease (CVD) is controversial. We critically evaluate 14 cohorts and meta-analyze the magnitude of CVD risk for the primary outcomes of CVD mortality, stroke, and myocardial infarction (MI), and establish subgroup risk for different psoriasis severities and age groups. Increased CVD risk was identified only in individuals with severe psoriasis (defined as requiring systemic therapy or hospital admission): the risk ratio relative to the general population was 1.37 (95% confidence interval (CI) 1.17-1.60) for CVD mortality, 3.04 (95% CI 0.65-14.35) for MI, and 1.59 (95% CI 1.34-1.89) for stroke. The relative risks of CVD were highest in the younger, severe psoriasis population (e.g., 3.10 (95% CI 1.98-4.86) for MI at 30 years), and absolute risks were greatest in older individuals with severe psoriasis (e.g., 23.2 excess MIs per 10,000 person-years at 60 years). Uncertainty remains about whether CVD risk is directly attributable to psoriasis, as the majority of studies failed to adequately adjust for key traditional risk factors.

AB - The relationship between psoriasis and increased risk of cardiovascular disease (CVD) is controversial. We critically evaluate 14 cohorts and meta-analyze the magnitude of CVD risk for the primary outcomes of CVD mortality, stroke, and myocardial infarction (MI), and establish subgroup risk for different psoriasis severities and age groups. Increased CVD risk was identified only in individuals with severe psoriasis (defined as requiring systemic therapy or hospital admission): the risk ratio relative to the general population was 1.37 (95% confidence interval (CI) 1.17-1.60) for CVD mortality, 3.04 (95% CI 0.65-14.35) for MI, and 1.59 (95% CI 1.34-1.89) for stroke. The relative risks of CVD were highest in the younger, severe psoriasis population (e.g., 3.10 (95% CI 1.98-4.86) for MI at 30 years), and absolute risks were greatest in older individuals with severe psoriasis (e.g., 23.2 excess MIs per 10,000 person-years at 60 years). Uncertainty remains about whether CVD risk is directly attributable to psoriasis, as the majority of studies failed to adequately adjust for key traditional risk factors.

KW - Cardiovascular Diseases

KW - Cardiovascular Diseases: epidemiology

KW - Cardiovascular Diseases: mortality

KW - Humans

KW - Incidence

KW - Psoriasis

KW - Psoriasis: epidemiology

KW - Psoriasis: mortality

KW - Risk Factors

U2 - 10.1038/jid.2013.149

DO - 10.1038/jid.2013.149

M3 - Article

C2 - 23528816

SN - 0022-202X

VL - 133

SP - 2340

EP - 2346

JO - Journal of Investigative Dermatology

JF - Journal of Investigative Dermatology

IS - 10

ER -