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Abstract：
Psoriasis is a chronic immune-mediated disease affecting the skin, nails, and/or joints. It is associated with systemic inflammation and may also be linked to an increased risk of atherosclerotic cardiovascular disease (ASCVD). The objectives of this study were to determine the overall risk of ASCVD in patients with psoriasis and to evaluate the risk according to ASCVD type and the severity of psoriasis. This was a systematic review and meta-analysis of observational studies reporting the association between psoriasis and one or more of the clinical types of ASCVD. We searched Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Excerpta Medica Database (EMBASE), Scopus, Bielefeld Academic Search Engine (BASE), and Google Scholar for relevant studies in the English language from the beginning of their records to July 2023. Study selection and data extraction were conducted by four independent reviewers. A total of 21 observational studies (three cross-sectional, one case-control, and 17 cohort) were included in this review, representing a total of 778,049 patients with psoriasis and 16,881,765 control subjects without psoriasis. The included studies had varying degrees of covariate adjustment, and thus, their findings may have been subject to residual confounding. All the meta-analyses used the adjusted effect sizes and were based on the random-effects model. However, the cohort studies were analysed separately from the non-cohort studies (the case-control and cross-sectional studies). There was a significant association between psoriasis and ASCVD (cohort studies: hazard ratio (HR), 1.21; 95% confidence interval (CI), 1.14 to 1.28; I2 = 63%; p < 0.001; non-cohort studies: odds ratio (OR), 1.60; 95% CI, 1.34 to 1.92; I2 = 31%; p = 0.23). Psoriasis was also significantly associated with myocardial infarction (cohort studies: HR, 1.20; 95% CI, 1.10 to 1.31; I2 = 60%; p < 0.001; non-cohort studies: OR, 1.57; 95% CI, 1.15 to 2.15; I2 = 74%; p = 0.05), coronary artery disease (cohort studies: HR, 1.20; 95% CI, 1.13 to 1.28; I2 = 67%; p < 0.001; non-cohort studies: OR, 1.60; 95% CI, 1.34 to 1.92; I2 = 31%; p = 0.23), aortic aneurysm (HR, 1.45; 95% CI, 1.04 to 2.02; I2 = 67%; p = 0.08) but not with ischaemic stroke (HR, 1.14; 95% CI, 0.96 to 1.36; I2 = 44%; p = 0.17). Pooled analysis in terms of the severity of psoriasis showed that both mild (cohort studies: HR, 1.17; 95% CI, 1.08 to 1.26; I2 = 74%; p < 0.001; non-cohort studies: OR, 1.54; 95% CI, 1.25 to 1.90; I2 = 0%; p = 0.50) and severe (cohort studies: HR, 1.43; 95% CI, 1.23 to 1.65; I2 = 65%; p < 0.001; non-cohort studies: OR, 1.65; 95% CI, 1.29 to 2.12; I2 = 25%; p = 0.26) psoriasis were significantly associated with ASCVD. Psoriasis (including mild and severe disease) is associated with an increased risk of ASCVD, including coronary artery disease (CAD) and aortic aneurysm (AA). ASCVD risk assessment and prevention should be prioritised in all adult psoriasis patients. Future observational studies investigating the association between psoriasis and ASCVD should conduct a more comprehensive adjustment of covariates.
摘要：
牛皮癣是一种慢性免疫介导的影响皮肤的疾病，指甲,和/或关节。它与全身性炎症有关，也可能与动脉粥样硬化性心血管疾病（ASCVD）的风险增加有关。这项研究的目的是确定银屑病患者ASCVD的总体风险，并根据ASCVD类型和银屑病的严重程度评估风险。这是一项观察性研究的系统评价和荟萃分析，报告了银屑病与一种或多种ASCVD临床类型之间的关联。我们通过PubMed在线搜索医学文献分析和检索系统(MEDLINE)，摘录医学数据库（EMBASE），Scopus,比勒费尔德学术搜索引擎（BASE），和谷歌学者从他们的记录开始到2023年7月的英语相关研究。研究选择和数据提取由四名独立评审员进行。总共21项观察性研究(三项横断面研究，一个病例控制，和17个队列)被包括在这篇综述中，代表总共778,049名牛皮癣患者和16,881,765名无牛皮癣的对照受试者。纳入的研究有不同程度的协变量调整，因此，他们的发现可能会受到残留的混淆。所有荟萃分析都使用调整后的效应大小，并基于随机效应模型。然而,队列研究与非队列研究(病例对照和横断面研究)分开分析.银屑病和ASCVD之间存在显著关联(队列研究：风险比(HR)，1.21；95%置信区间(CI)，1.14至1.28；I2=63%；p<0.001；非队列研究：比值比（OR），1.60；95%CI，1.34至1.92；I2=31%；p=0.23）。银屑病也与心肌梗死显著相关(队列研究：HR，1.20；95%CI，1.10~1.31；I2=60%；p<0.001；非队列研究：OR，1.57；95%CI，1.15至2.15；I2=74%；p=0.05），冠状动脉疾病(队列研究：HR，1.20；95%CI，1.13~1.28；I2=67%；p<0.001；非队列研究：OR，1.60；95%CI，1.34至1.92；I2=31%；p=0.23），主动脉瘤（HR，1.45；95%CI，1.04至2.02；I2=67%；p=0.08），但与缺血性卒中无关（HR，1.14；95%CI，0.96至1.36；I2=44%；p=0.17)。就银屑病的严重程度进行汇总分析显示，两者均为轻度（队列研究：HR，1.17；95%CI，1.08~1.26；I2=74%；p<0.001；非队列研究：OR，1.54；95%CI，1.25至1.90；I2=0%；p=0.50）和严重（队列研究：HR，1.43；95%CI，1.23~1.65；I2=65%；p<0.001；非队列研究：OR，1.65；95%CI，1.29~2.12；I2=25%；p=0.26）银屑病与ASCVD显著相关。银屑病（包括轻度和重度疾病）与ASCVD的风险增加有关。包括冠状动脉疾病（CAD）和主动脉瘤（AA）。所有成人银屑病患者应优先考虑ASCVD风险评估和预防。未来的观察性研究调查银屑病和ASCVD之间的关联应该进行更全面的协变量调整。
