Updated and contextualized version of an article originally published on May 6, 2014
The article retains its original focus by presenting it through a scholarly and accessible perspective, supported by verifiable references.
Authors
- Dr. A. Colonnese – Nutrition biologist
- Roberto Panzironi –Independent researcher
Note editoriali
- First publication: May 6, 2014
- Last update: April 18, 2026
- Version: 2026 narrative revision
Initial Note
The following article is an editorial and scientific update of previously published content. It has been revised to reflect the most robust epidemiological evidence and main literature contributions available, with language designed for a general audience interested in reliable medical-scientific information. The text is for informational purposes only and in no way replaces the advice of a treating physician. In case of personal doubts or therapeutic choices, consult your primary care physician.
In brief
- Observational studies indicate that people with psoriasis have an increased relative risk of atrial fibrillation and ischemic stroke compared to the general population.
- The increased risk appears to be greater in more severe forms of psoriasis and in younger individuals, but the relationship is epidemiological (associative) in nature, not demonstrating direct causality.
- Plausible biological explanations include systemic inflammation, a higher prevalence of cardiovascular risk factors, and possible effects on endothelial function and coagulation.
- The evidence does not allow us to state that skin care automatically reduces the risk of stroke; large-scale controlled studies are needed to answer this question.
These points summarize the central messages; for an in-depth reading, summaries of the evidence, practical considerations, study limitations, and verified primary references follow.
Abstract: what does science say?
Psoriasis is a chronic inflammatory skin disease that, in addition to skin manifestations, has been associated with systemic comorbidities. Numerous observational studies on large cohorts report an increased relative risk of cardiovascular events, particularly atrial fibrillation and ischemic stroke, with a more pronounced signal in severe forms of psoriasis. The strength of the association varies among studies; in many cases, the relationship shows dependence on disease severity and the coexistence of cardiometabolic risk factors. Current evidence primarily comes from observational studies and meta-analyses: these can document correlations and suggest biological plausibility (systemic inflammation, endothelial dysfunction), but do not definitively demonstrate a unique causal mechanism. In summary, there is epidemiological evidence of an increased cardiovascular risk in people with psoriasis, but clinical translation requires cautious interpretation and attention to modifiable risk factors.
What it means in practice
Interpreting risk: relative vs. absolute
Population studies have shown that, compared to the general population, people with psoriasis have a higher relative risk of atrial fibrillation and ischemic stroke: a large Danish cohort study highlighted increased risk ratios, particularly in younger patients and in severe forms [1]. It is important to distinguish between relative risk and absolute risk: a doubling of relative risk can translate into a modest increase in the absolute number of events if the baseline frequency is low. This means that, while the signal is relevant for public health and clinical surveillance, the individual probability of an event must be assessed on a case-by-case basis [1].
Role of disease severity
The literature suggests a "dose-dependent" relationship: forms of psoriasis considered severe contribute more to the overall risk of cardiovascular events than mild forms [2]. The data show that the impact on cardiovascular health is not uniform: people with extensive skin involvement or requiring systemic therapies have shown more marked increases in risk in some studies [2][3]. However, not all studies fully agree, and the measure of effect may vary depending on the definitions of severity used in the study [5].
What biological mechanisms explain the association?
Systemic inflammation and atherosclerosis
Psoriasis is characterized by immune activation and the production of pro-inflammatory cytokines that can promote endothelial dysfunction processes and favor atherosclerosis. Reviews and synthesis works indicate that this systemic inflammation is a plausible biological pathway connecting the skin disease to cardiovascular events, providing an interpretive framework consistent with epidemiological data [8].
Shared risk factors and metabolic comorbidities
People with psoriasis more frequently exhibit conditions such as obesity, metabolic syndrome, hypertension, and diabetes, which are themselves known risk factors for stroke and arrhythmias. Part of the signal observed in epidemiological studies may therefore reflect this higher prevalence of comorbidities; studies that adjust for these factors often see the association attenuate, but not always disappear [7].
Key takeaways
- Psoriasis is associated with an increased relative risk of atrial fibrillation and ischemic stroke in most significant observational studies [1].
- The risk tends to be higher in severe forms of psoriasis and in younger individuals, but the observed relationship is associative, not demonstrating direct causality [2][3].
- Plausible mechanisms include chronic systemic inflammation and a higher prevalence of shared cardiovascular risk factors [8].
- Meta-analyses of large databases agree on a modest overall increase in cardiovascular risk; however, results between studies are not perfectly superimposable, and the strength of the association varies [6][7][9].
Limitations of the Evidence
Most of the data comes from observational studies (cohorts and retrospective analyses) and meta-analyses of these studies. To be clear: observational studies can identify associations and suggest plausibility, but they do not establish incontrovertible causality. Many studies attempt to correct for confounders (smoking, obesity, hypertension, diabetes), however, residual confounding and differences in the definition of psoriasis severity remain a source of uncertainty [6][7].
Some specific limitations include: variable measurement of skin severity, possible classification errors, heterogeneous follow-up durations, and geographical and demographic differences between cohorts. Furthermore, data on the effect of systemic anti-inflammatory therapies on reducing cardiovascular risk are still partial and inconclusive [5][9]. For these reasons, clinical recommendations cannot be based solely on the existence of the association: controlled clinical trials are needed to clarify the impact of targeted therapies on cardiovascular risk.
Editorial conclusion
Available epidemiological evidence consistently indicates that psoriasis is associated with an increased relative risk of atrial fibrillation and ischemic stroke, with greater intensity in severe forms and in certain age groups [1][2][3]. This association is plausibly mediated by systemic inflammation and the higher prevalence of cardiometabolic risk factors among people with psoriasis [8].
From a practical standpoint, the central message for professionals and the public is the need for an integrated approach: psoriasis management should include attention to known cardiovascular risk factors, periodic assessment of cardiometabolic status, and clear communication with the patient. However, at present, we do not have conclusive experimental evidence that treating the skin disease alone automatically reduces the risk of stroke; for this, randomized and long-term clinical trials are needed. In the meantime, it is reasonable to adopt prudent and evidence-based clinical behavior: monitor and correct modifiable risk factors, provide clear information to patients, and consider multidisciplinary collaboration among dermatologists, cardiologists, and general practitioners.
Editorial note
This article has been updated to integrate and concisely describe the main evidence regarding the association between psoriasis and the risk of cerebrovascular and cardiovascular events. The update follows criteria of transparency, clarity, and traceability of scientific sources. The material published here is intended for general public information and does not constitute a therapeutic guide. For clinical decisions or individual situations, consult your treating physician.
SCIENTIFIC RESEARCH
- Ahlehoff O, Gislason GH, Jørgensen CH, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study. Eur Heart J. https://doi.org/10.1093/eurheartj/ehr285. [1]
- Mehta NN, Yu Y, Pinnelas R, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med. https://doi.org/10.1016/j.amjmed.2011.03.028. [2]
- Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA. https://doi.org/10.1001/jama.296.14.1735. [3]
- Gelfand JM, Dommasch ED, Shin DB, et al. The risk of stroke in patients with psoriasis. J Invest Dermatol. https://doi.org/10.1038/jid.2009.112. [4]
- Parisi R, Rutter MK, Lunt M, et al. Psoriasis and the risk of major cardiovascular events: cohort study using the Clinical Practice Research Datalink. J Invest Dermatol. https://doi.org/10.1038/jid.2015.87. [5]
- Armstrong AW, Harskamp C, Armstrong EJ. Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies. J Am Heart Assoc. https://doi.org/10.1161/JAHA.113.000062. [6]
- Incidence of cardiovascular disease in individuals with psoriasis: a systematic review and meta-analysis. J Invest Dermatol. https://doi.org/10.1038/jid.2013.149. [7]
- Review: Systemic inflammation and cardiovascular comorbidity in psoriasis patients (Frontiers in Immunology). https://doi.org/10.3389/fimmu.2018.00579. [8]
- Large‑scale cohort meta‑analysis: Psoriasis increased the risk of adverse cardiovascular outcomes: systematic review and meta‑analysis of cohort studies. Front Cardiovasc Med. https://doi.org/10.3389/fcvm.2022.829709. [9]