Psoriasis and Cardiovascular Risk: What the Research Shows

Psoriasis's connection to cardiovascular disease is one of the best-established, most extensively studied aspects of the condition's systemic impact — backed by some of the largest patient datasets in dermatology research. Here's what the evidence actually shows.

The Scale of the Evidence

This isn't a single small study — the evidence base here is unusually large and consistent. A 2022 meta-analysis pooling 31 studies covering 665,009 psoriasis patients and nearly 18 million control subjects found significantly elevated risk across multiple cardiovascular outcomes: a 17% increased risk of myocardial infarction (heart attack), 19% increased risk of stroke, 46% increased risk of cardiovascular death, and elevated risk of thromboembolism and arrhythmia.

A separate, more recent 2026 meta-analysis focused specifically on stroke, covering 18 studies and over 700,000 psoriasis patients, found a pooled 24% increased stroke risk overall — rising further with disease severity.

Severity Matters — A Lot

Across virtually every major study in this area, one pattern holds consistently: risk scales with psoriasis severity. In the 2022 meta-analysis, mild psoriasis carried an 18% increased risk of adverse cardiovascular outcomes, while severe psoriasis carried a 41% increased risk. An earlier, highly-cited meta-analysis found severe psoriasis specifically associated with a 70% increased risk of heart attack and 56% increased risk of stroke — substantially higher than the risk seen with mild disease. One study estimated this translates to roughly 11,500 excess major adverse cardiovascular events annually attributable to psoriasis.

Why This Connection Exists

Psoriasis and cardiovascular disease appear to share underlying inflammatory biology, not just coincidental risk factors. Shared mechanisms proposed by researchers include Th1-mediated inflammation, altered blood vessel formation (angiogenesis), and endothelial dysfunction — the same inflammatory pathways driving skin plaques may also promote atherosclerosis and blood vessel damage elsewhere in the body. This is part of why modern dermatology increasingly treats psoriasis as a systemic inflammatory condition rather than a purely dermatological one.

What About Treatment?

Interestingly, a meta-analysis of 38 randomized controlled trials of biologic treatments (nearly 18,000 patients) found no statistically significant difference in cardiovascular events across major biologic drug classes — suggesting biologics themselves aren't clearly adding cardiovascular risk on top of psoriasis. One specific caution: TNF-alpha inhibitors are not recommended for psoriasis patients with a history of heart failure, given evidence of worse outcomes in that specific population.

What This Means Practically

• This is a legitimate reason for routine cardiovascular screening if you have psoriasis, particularly moderate-to-severe disease — blood pressure, cholesterol, and blood sugar monitoring are all reasonable conversations to have with your doctor
• Managing psoriasis severity may have cardiovascular benefits beyond skin symptoms — though this hasn't been definitively proven as a causal relationship, the strong severity-gradient pattern is suggestive
• Standard cardiovascular risk reduction still applies — the general population's cardiovascular risk factors (smoking, diet, exercise, weight) remain relevant and, if anything, more consequential for people with psoriasis
• Don't avoid biologic treatment out of cardiovascular concern based on the available trial evidence, though always discuss your individual risk profile with your doctor

Frequently Asked Questions

Does having mild psoriasis still carry cardiovascular risk?

Yes, though the risk is meaningfully lower than with severe psoriasis — several studies found statistically significant elevated risk even in mild disease, just at a smaller magnitude.

Should I be screened for heart disease if I have psoriasis?

This is worth discussing directly with your doctor — given the strength and consistency of this research, many guidelines now recommend more attentive cardiovascular risk assessment for people with moderate-to-severe psoriasis specifically.

Next Steps

For the full picture on psoriasis's systemic health connections, see our article on psoriasis as a systemic condition.

This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Discuss cardiovascular risk screening with your doctor.

Sources & References

• Psoriasis Increased the Risk of Adverse Cardiovascular Outcomes: A New Systematic Review and Meta-Analysis of Cohort Study. PMC8990932
• Increased risk of stroke in patients with psoriasis: A systematic review and meta-analysis. PMC13008219
• Psoriasis and Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Observational Studies. Journal of the American Heart Association. PMC3647278
• Cardiovascular Risk in Patients With Psoriasis: JACC Review Topic of the Week. JACC