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La psoriasi aumenta il rischio cardiovascolare

La psoriasi è una malattia infiammatoria cronica della pelle che interessa circa il 2-3% della popolazione mondiale. I pazienti con psoriasi hanno una maggiore prevalenza, rispetto alla popolazione generale, di fattori di rischio cardiovascolare quali ipertensione, diabete, obesità e dislipidemia e mostrano anche una maggiore incidenza di eventi cardiovascolari maggiori. La meta-analisi di Armstrong e Coll. conferma l'esistenza di un'associazione tra psoriasi e malattie cardiovascolari, estendendola anche alla psoriasi moderata e non solo a quella grave, come era stato documentato in precedenza. Senza entrare nel merito dei possibili meccanismi alla base dell'associazione, si suggerisce che la psoriasi debba avere un significato di fattore di rischio cardiovascolare. La cura della psoriasi, come approccio al controllo del rischio cardiovascolare è difficile e di esito incerto e per di più non si hanno dati certi che possa ridurre efficacemente il rischio. Non rimane che il controllo più aggressivo dei classici fattori di rischio.

Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies

Armstrong EJ, Harskamp CT, Armstrong AW

J Am Heart Ass 2013;2:e000062

BACKGROUND: Psoriasis is a chronic inflammatory disease that may be associated with increased risk of cardiovascular events, including cardiovascular mortality, myocardial infarction, and stroke.
METHODS AND RESULTS: We searched the MEDLINE, EMBASE, and Cochrane Central Register databases for relevant studies in English between January 1, 1980, and January 1, 2012. Extraction was by 3 independent reviewers. Summary incidence, risk ratios (RRs), and confidence intervals (CIs) were calculated using fixed-effects and random-effects modeling. Meta-regression was also performed to identify sources of between-study variation. Nine studies were included, representing a total of 201 239 patients with mild and 17 415 patients with severe psoriasis. The level of covariate adjustment varied among studies, leading to the possibility of residual confounding. Using the available adjusted effect sizes, mild psoriasis remained associated with a significantly increased risk of myocardial infarction (RR, 1.29; 95% CI, 1.02 to 1.63) and stroke (RR, 1.12; 95% CI, 1.08 to 1.16). Severe psoriasis was associated with a significantly increased risk of cardiovascular mortality (RR, 1.39; 95% CI, 1.11 to 1.74), myocardial infarction (RR, 1.70; 95% CI, 1.32 to 2.18), and stroke (RR, 1.56 95% CI, 1.32 to 1.84). Based on these risk ratios and the background population event rates, psoriasis is associated with an estimated excess of 11 500 (95% CI, 1169 to 24 407) major adverse cardiovascular events each year.
CONCLUSIONS: Mild and severe psoriasis are associated with an increased risk of myocardial infarction and stroke. Severe psoriasis is also associated with an increased risk of cardiovascular mortality. Future studies should include more complete covariate adjustment and characterization of psoriasis severity.

J Am Heart Ass 2013;2:e000062