Introduction

Psoriasis is a chronic, systemic immune-mediated inflammatory disorder associated with an increased risk of cardiovascular disease, independent of conventional cardiovascular risk factors. Accelerated atherosclerosis, fuelled by common inflammatory pathways, is thought to constitute the fundamental connection between psoriasis and cardiovascular disease.

Aim

This systematic review's goal was to gather information from observational studies evaluating the connection between psoriasis and subclinical atherosclerosis as identified by inflammatory biomarkers and imaging techniques.

Methods

Following PRISMA 2020 criteria, a comprehensive search of the literature was conducted in PubMed/Medline, Embase, Web of Science, and Scopus up to a designated date. Observational studies comparing persons with psoriasis to healthy controls to examine subclinical atherosclerosis were included. Imaging indicators (such as the burden of coronary plaque as well as carotid intima-media thickness [CIMT]) and circulating biomarkers (such as IL-17 and MHR) were the main results. The Newcastle-Ottawa Scale was employed to assess the study's quality.

Results

A total of 16 studies were included. When compared to matched controls, the data consistently showed that psoriasis patients had a much greater burden of subclinical atherosclerosis, i.e. increased CIMT, a higher load of lipid-rich as well as non-calcified coronary plaque on coronary CT angiography, and elevated levels of pro-atherogenic biomarkers (e.g., MHR, IL-17, GDF-15). Mechanistic studies revealed a pro-atherogenic monocyte phenotype and complement system involvement. Critically, effective systemic treatment with methotrexate or biologic agents (IL-17/23 inhibitors) was associated with improvement in these atherosclerotic markers and arterial stiffness.

Conclusions

Based on similar inflammatory pathways, this review offers compelling evidence that psoriasis and subclinical atherosclerosis are closely related. The results highlight the necessity of a paradigm change in psoriasis treatment in favour of comprehensive cardiovascular risk assessment and monitoring. Emerging evidence suggests that anti-inflammatory therapy for psoriasis may concurrently ameliorate vascular inflammation and reduce atherosclerotic burden.