Psoriasis and atherosclerosis: two plaques, one syndrome?

Study' † , by O. Ahlehoff et al., on page 2054Psoriasis is a chronic inflammatory disease affecting up to 2% of the global population.While the pathogenesis of psoriasis is not fully understood yet, an increasing body of evidence suggests a genetic predisposition and an environmental component.The most common manifestations are papulosquamous plaques symmetrically located on extensor surfaces of the joints.While most psoriasis patients report that their skin manifestations have a negative impact on their quality of life, psoriasis is not just a skin disease.Indeed, similarly to other systemic inflammatory diseases, inflammation is widespread in psoriasis, and arthritis is found in up to a quarter of patients and precedes the disease in 10% of the patients. 1Importantly, life expectancy is reduced in psoriasis by up to 4 years, which has been attributed to a higher incidence of cardiovascular diseases. 2hlehoff et al. now report an association of psoriasis with increased risk of atrial fibrillation and ischaemic stroke. 3The authors analysed 36 765 patients with mild and 2793 patients with severe psoriasis and compared these with .4 million individuals of a nationwide Danish registry.Indeed, several important pieces of information can be retrieved from this study.First, the study is a further epidemiological milestone in delineating the associated risk of not only severe but also mild psoriasis with vascular disease.Secondly, the study demonstrates a considerably elevated risk not only for cardiovascular disease per se but also for atrial fibrillation and ischaemic stroke, in particular.While confounding and misclassification might be a concern in any registry-based study, the authors provide further evidence that psoriasis is not just a skin disease, but indeed a systemic disease.Notwithstanding that patients with psoriasis have a high prevalence of cardiovascular