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Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors

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Background

The possible connection between psoriasis with cardiovascular disease and associated risk factors has been implied, but inconsistent results have been reported.

Objective

We sought to create an overview and statistical summary of the previous literature with elucidating subgroup analysis.

Methods

This was a meta-analysis of observational studies using random effect statistics. A systematic search of observational studies of psoriasis as study variable and cardiovascular disease and associated risk factors as outcome, published before October 25, 2012, was conducted.

Results

Of 835 references in the original search, 75 relevant articles were identified. We included 503,686 cases and 29,686,694 controls. Psoriasis was associated with cardiovascular disease in total (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.2-1.7), ischemic heart disease (OR 1.5; 95% CI 1.2-1.9), peripheral vascular disease (OR 1.5; 95% CI 1.2-1.8), atherosclerosis (OR 1.1; 95% CI 1.1-1.2), diabetes (OR 1.9; 95% CI 1.5-2.5), hypertension (OR 1.8; 95% CI 1.6-2.0), dyslipidemia (OR 1.5; 95% CI 1.4-1.7), obesity by body mass index (OR 1.8; 95% CI 1.4-2.2), obesity by abdominal fat (OR 1.6; 95% CI 1.2-2.3), and the metabolic syndrome (OR 1.8; 95% CI 1.2-2.8), but not associated with cerebrovascular disease (OR 1.1; 95% CI 0.9-1.3) and cardiovascular mortality (OR 0.9; 95% CI 0.4-2.2). The strongest associations were seen in hospital-based studies and psoriatic arthritis. Population-based studies did not show significant associations, with the exception of dyslipidemia.

Limitations

The heterogeneity of the studies makes clinical interpretation challenging.

Conclusions

In aggregate, psoriasis was associated with ischemic heart disease and cardiovascular risk factors. The association was only significant for hospital-based studies, except for dyslipidemia, which was also significant in population-based studies.

Section snippets

Methods

The study was conducted in accordance to Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations.10

Literature search

We found 800 references in databases, and an additional 35 by manual screening. We excluded 760 references (Fig 1 and efile1).

A total of 75 studies including up to 503,686 cases and 29,686,694 controls covering 12 different end points were included in the meta-analyses (Fig 2, Fig 3, Fig 4, Fig 5, Fig 6). Some controls overlap if more than 1 end point from the same study is analyzed.

Cardiovascular disease

Using random effects model, psoriasis was associated with cardiovascular disease in total (odds ratio [OR] 1.4;

Discussion

To our knowledge, this study is the largest meta-analysis undertaken to study the association of psoriasis and cardiovascular diseases as well as associated risk factors with 75 studies, covering 503,686 cases and 29,686,694 controls.

In aggregate, psoriasis was associated with cardiovascular disease in total and associated risk factors, but not cerebrovascular disease and cardiovascular mortality. In subgroup analyses, hospital-based studies and insurance database studies demonstrated an

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Cofinanced with grants by the Danish Agency for Science, Technology, and Innovation and LEO Pharma A/S (Dr Miller).

Disclosure: Dr Miller is cofinanced by LEO Pharma A/S. Dr Jemec reports receiving consulting fees from Abbott Laboratories, Astra-Zeneca, Coloplast, MSD, Novartis, Pfizer, and Dumex-Alpharma; lecture fees from Abbott Laboratories, Galderma, Pfizer, and Roche; grant support from Abbott Laboratories, Pfizer, Photocure, and LEO Pharma; equipment on loan from Michelson Diagnostics; and reimbursement for travel expenses from Abbott Laboratories, Galderma, and Photocure. Drs Ellervik, and Yazdanyar have no conflicts of interest to declare.

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