The Link Between Psoriasis and Cardiovascular Disease Risk in European and East Asian Populations

Psoriasis has long been linked to cardiovascular disease, including coronary artery disease, myocardial infarction, and heart failure.

Psoriasis causes inflammation on the skin and inside the body, and long-lasting inflammation inside one’s body can impact the heart and blood vessels, creating at greater risk of developing heart disease or having a stroke.

Still, available studies regarding this relationship between psoriasis and cardiovascular disease have shown inconsistent results.

That led to a recent review led by Liming Zhang, dermatologist at The First Hospital of China Medical University in Shenyang, China, which offered a comprehensive review of the literature to assess the effects of psoriasis on risk of common cardio vascular diseases (CVDs).

Zhang and his fellow authors conducted a search of literature utilizing PubMed, the Cochrane Library, Web of Science, Google Scholar, and Embase, looking within European and East Asian populations for meta-analyses of observational studies assessing correlations between psoriasis and various CVD risk factors.

The search strategy for the literature was adapted to the format of each database and the study was based on the Preferred Reporting Items for Systematic Review (PRISMA) reporting guidelines.

Additionally, a manual reviewing of the reference lists of all relevant articles was conducted to identify further relevant literature.

“We performed meta-analyses of observational studies to describe the relationships of psoriasis with CVE risk in European and East Asian populations in order to determine if the relationship of psoriasis with CVE risk is congruent with causal associations,” Zhang said. “Subsequently, we conducted a two-sample Mendelian randomization to assess the evidence for causative impact of genetic pre-disposition for psoriasis on these CVD risk factors.”

The study authors believe their report to be the first one employing meta-analysis and MR to investigate causative associations between psoriasis and CAD, MI, and HF risk in European and East Asian populations.

“In our observational analyses, we found that psoriasis was remarkably associated with a higher risk of incident CAD and MI and was not associated with HF risk,” the authors wrote. “In order to eliminate the potential for interference of cardiovascular risk factors in the analysis of correlations between psoriasis and CAD, MI, and HF, only correlations between psoriasis and CAD, MI and HF were included in the analysis.”

So, correlations between psoriasis and peripheral vascular disease, atherosclerosis, and other cardiovascular diseases or cardiovascular risk factors were not analyzed.

However, in the studies the authors looked at, control groups were closely matched with cardiovascular risk factors of psoriasis patients or adjusted for cardiovascular risk factors.

The researchers gleaned some significant things from the review. For one, the results of the meta-analyses indicated that in both the European and East Asian populations, psoriasis
was significantly linked to an elevated risk in the incidence of CAD.

“We also established that psoriasis was causally linked with an elevated risk of MI in
the European population as determined using an MR approach,” Zhang said. “Furthermore, the MR results were congruent with the null findings from the meta-analysis assessing associations of psoriasis with HF risk.”

The authors concluded that the results successful established a causal association of psoriasis with CAD and MI.

“Such findings have important implications as they provide further support for the targeted treatment of psoriasis as a means of enhancing beneficial effects upon cardiovascular outcomes,” Zhang said. “The possible mechanisms accounting for this causal relationship of psoriasis with CAD and MI require further investigation.”

The research provides preliminary evidence that psoriasis and CVD have a common genetic origin and that targeted psoriasis treatment might improve cardiovascular outcomes. Therefore, the results not only improve the understanding of the genetic underpinnings linking a comorbidity of psoriasis with CVD, but also suggests an untested novel approach for CVD prevention.


Reference
1. Zhang, L., Wang, Y., Qiu, L. et al. Psoriasis and cardiovascular disease risk in European and East Asian populations: evidence from meta-analysis and Mendelian randomization analysis. BMC Med 20, 421 (2022). https://doi.org/10.1186/s12916-022-02617-5