Background/Purpose: Psoriasis, affecting 2–3% of the global population, is a chronic inflammatory disease with systemic effects beyond the skin. Its immune-mediated inflammation contributes to cardiovascular comorbidities including hypertension, diabetes, and atherosclerosis. Th1/Th17-driven pathways accelerate vascular risk, linking psoriasis to stroke. However, data on stroke risk remain limited due to small cohorts and insufficient confounder adjustment.

Methods: This meta-analysis evaluated the association between psoriasis and stroke by systematically reviewing observational studies published through December 2024. Study selection followed PRISMA guidelines, extracting data on patient characteristics and adjusted risk estimates.

Results: This meta-analysis of 18 studies encompassing 705,602 psoriasis patients and over 17.9 million controls demonstrated a significant association between psoriasis and stroke, with a pooled hazard ratio (HR) of 1.24 (95% CI: 1.15–1.35). Stratified analyses showed elevated stroke risk across all severities: mild (HR: 1.09; 95% CI: 1.02–1.16), overall (HR: 1.34; 95% CI: 1.05–1.73), and severe psoriasis (HR: 1.36; 95% CI: 1.21–1.53). Region-specific estimates indicated consistent associations in Asia (HR: 1.08), Europe (HR: 1.26), and North America (HR: 1.49), though with some heterogeneity. Age subgroup analysis also confirmed increased stroke risk in both older (≥45 years, HR: 1.27) and younger ( < 45 years, HR: 1.18) patients. No significant publication bias or small-study effects were detected by funnel plot analysis and statistical testing.

Conclusion: This analysis confirms that psoriasis is associated with an increased risk of stroke, particularly in patients with severe disease. The association remains consistent across age groups and geographic regions. These findings highglight the need for routine cardiovascular risk assessment in psoriasis care. Future research should explore targeted anti-inflammatory therapies and lifestyle interventions to mitigate stroke risk in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-stroke-in-patients-with-psoriasis-a-systematic-review-and-meta-analysis/