Study Suggests Causal Link Between Psoriasis, Cardiovascular Disease

There is evidence for a causal link between psoriasis and cardiovascular disease (CVD), suggesting the importance of early monitoring of cardiovascular risk in patients with psoriasis, according to a study recently published in Frontiers in Immunology.

Although patients with psoriasis are known to have a higher risk for CVD, this study builds upon previous research by investigating a causal link between psoriasis and CVD.

“A large number of observational studies showed that patients with psoriasis have a higher risk of CVD, but most studies did not fully adjust for confounding factors, so it is not clear whether the risk of CVD is directly attributed to psoriasis,” wrote the authors.

They conducted a 2-sample Mendelian randomization to evaluate the potential causal relationship between psoriasis and CVD using genetic evidence. Genetic instruments from the genome-wide association study of European descent for psoriasis were used to investigate the relationship. Inverse variance-weighted Mendelian randomization analyses were used, in addition to a variety of other methods.

The analysis indicated that genetic susceptibility to psoriasis was associated with a higher risk of multiple CVDs. Psoriasis was associated with a higher risk of heart failure (odds ratio [OR], 1.04; 95% CI, 1.01-1.06; P = 2.72E-03), atrial fibrillation (OR, 1.04; 95% CI, 1.02-1.07; P = 3.27E04), myocardial infarction (OR, 1.07; 95% CI, 1.01-1.12; P = .01), valvular heart disease (OR, 1.001; 95% CI, 1.000-1.002; P = 1.85E-03), and large artery stroke (OR, 1.11; 95% CI, 1.05-1.18; P = 5.37E-04).

Notably, susceptibility to psoriasis was found to not be associated with a higher risk of ischemic stroke (OR, 1.03; 95% CI, 0.98-1.07; P = .27) or small vessel stroke (OR, 1.00; 95% CI, 0.95-1.07; P = .88).

The sensitivity analysis found weak evidence of horizontal diversity and heterogeneity, ensuring the stability of the results.

Overall, these findings provide evidence for a potential causal relationship between psoriasis and CVD.

The exact mechanism by which psoriasis increases the risk of CVD, if it increases the risk at all, has been debated in previous research. Studies on the relationship between psoriasis and CVD did not adjust for confounding factors, the authors of the present investigation noted, preventing the establishment of a causal relationship.

A strength of this study is that it explores this causal relationship between psoriasis and a series of CVDs. The authors assert that their results are unlikely to be influenced by confounders. Additionally, multiple analytical tools used produced consistent results, while the sensitivity analysis indicated the study results were reliable.

However, the study also faced limitations. The authors acknowledge that the OR value is relatively low, necessitating careful interpretation when generalizing results.

The researchers encourage more in-depth research on the relationship between psoriasis and CVD with a broader population beyond Europe. They also recommend early cardiovascular risk assessment and prevention in patients with psoriasis to facilitate the introduction of individual-specific treatments as soon as possible.

Reference

Gao N, Kong M, Li X, et al. The association between psoriasis and risk of cardiovascular disease: a Mendelian randomization analysis. Front Immunol. Published online June 29, 2022. doi:10.3389/fimmu.2022.918224