Severe Psoriasis Linked to a Higher Risk for Heart Disease, Study Confirms

Doug Brunk

September 20, 2023


In a large cross-sectional study, nearly one third of patients with severe psoriasis met criteria for coronary microvascular dysfunction.


  • Prior studies with small sample sizes have shown that coronary microvascular dysfunction (CMD) predicts poor cardiovascular outcomes in patients with severe psoriasis.

  • In a prospective multi-center study, researchers enrolled 448 patients with moderate to severe psoriasis with no documented clinical cardiovascular disease who underwent transthoracic Doppler echocardiography to evaluate coronary microcirculation.

  • The outcome variable of interest was CMD, defined as a coronary flow rate ≤ 2.5 mL.

  • The researchers used multivariable linear regression to model the associations of the characteristics of patients with psoriasis with CMD.


  • Of the 448 patients, 141 (31.5%) showed CMD.

  • Multivariable regression revealed four variables independently associated with CMD: higher psoriasis area severity index (PASI) score (per unit, odds ratio [OR], 1.058; P < .001), duration of psoriasis (per year; OR, 1.046; P < .001), the presence of psoriatic arthritis (OR, 1.938; P = .015), and hypertension (OR, 2.169; P = .010).

  • An increase of 1 point in the PASI score and 1 year of psoriasis duration were associated with a 5.8% and a 4.6% increased risk for CMD, respectively.


"We should diagnose and actively search for microvascular dysfunction in patients with psoriasis, as this population is at particularly high risk," the researchers conclude.


Stefano Piaserico, MD, PhD, of the University of Padova, Italy, led the research. The study was published in the Journal of Investigative Dermatology.


A small proportion of patients in the study were being treated for psoriasis, and other tools for assessing CMD were not used, such as PET-CT and cardiovascular MRI.


The authors reported having no relevant financial disclosures.

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