Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies

Background Psoriasis is a common, chronic, relapsing, inflammatory skin disorder. Observational studies suggest an association between psoriasis and the incidence of stroke or myocardial infarction (MI). However, whether psoriasis is an independent risk factor for these two vascular events remains controversial. Objectives To evaluate the association of psoriasis with stroke and MI by conducting a meta-analysis of cohort studies. Methods Cohort studies were searched in MEDLINE (Pubmed), EMBASE and Cochrane Library from their inception to March 2012. Stroke and MI were considered as a composite endpoint. Two authors independently extracted information on the characteristics of the study participants, follow-up range and control for potential confounding factors. A random-effects model was used to calculate the overall combined risk estimates. Results Seven cohort studies were included in the meta-analysis. On the basis of cohort characteristics, five of them were considered good quality and two were fair. The overall combined relative risk for psoriasis and composite vascular endpoint was 1.2 (95% confidence interval 1.11.31). Subgroup analysis maintained this significance with respect to stroke and MI individually. Sensitivity analysis and trim and fill method yielded similar results. No evidence of publication bias was observed. Conclusions This meta-analysis of cohort studies suggests that psoriasis significantly increases the risk of stroke and MI. The increase is probably independent of conventional cardiovascular risk factors.