Risk of Cardiovascular Disease in Patients with Psoriasis and Atopic Dermatitis

Author(s): Sara Almalik, Fazeela Ansari, Mahra Khaled AlShehhi, Majid Alhammadi, Alma Alfakhori, Jennifer John, Shaima Ahmad, Sammar Abbas Eltegani Mohamed, Meghavi saharan, Lakshya bhargava, Risalatelislam Babiker Mohammed, Abdelslam Hatim Elsamani

Background: Psoriasis and atopic dermatitis (AD) are chronic inflammatory skin conditions that are now recognized as systemic diseases. It is still a matter of debate whether they, as separate entities, increase risk of cardiovascular disease.

Methods: We systematically reviewed observational studies and meta-analyses that compare the risk of CVD in adults with psoriasis or AD to that of individuals without these diseases. The eligible designs were cohort, case–control and large cross-sectional studies that report relative risks (RRs), hazard ratios (HRs) or odds ratios (ORs) for major cardiovascular outcomes. The data were combined through random-effects models. As a measure of heterogeneity, we used I².

Results: Psoriasis was linked to an elevated risk of myocardial infarction (MI; pooled RR 1.17, 95% CI 1.11–1.24), stroke (1.19, 1.11–1.27), cardiovascular death (1.46, 1.26–1.69), ischemic heart disease (1.17, 1.02–1.34), thromboembolism (1.36, 1.20–1.55) and arrhythmia (1.35, 1.30–1.40) [7]. Atopic eczema/dermatitis was correlated with slightly increased risks of MI (RR 1.12, 1.00–1.25), stroke (1.10, 1.03–1.17), ischemic stroke (1.17, 1.14–1.20), angina (1.18, 1.13–1.24) and heart failure (1.26, 1.05–1.51) [4]. Our secondary meta-analysis of different cardiovascular endpoints indicated an overall relative risk (RR) of 1.27 (95% CI 1.18–1.37; I² ≈ 82%) for psoriasis, meaning 27% higher cardiovascular risk in patients with psoriasis and 1.16 (95% CI 1.13–1.19; I² ≈ 15%) for AD, indicating 16% higher risk.

Conclusion: Both psoriasis and AD carry a small to moderate risk of CVD and is more pronounced in the case of severe disease. Along with the aggressive management of these diseases, routine cardiovascular risk assessment should also be a goal in these patients. The next research should identify causal pathways through individual-patient data and Mendelian randomization.