Cardiovascular Risk in Psoriasis Compared With Atopic Dermatitis: The Shizuoka Kokuho Database

Psoriasis is a chronic inflammatory skin disease, and previous studies among Western populations have suggested an increased risk of cardiovascular events in patients with psoriasis. However, evidence from Asian populations remains limited. We evaluated the risk of major adverse cardiovascular events (MACE) in patients with psoriasis compared with patients who have atopic dermatitis (AD) using a large-scale administrative claims database from Shizuoka, Japan. We conducted a cohort study using the Shizuoka Kokuho Database, including patients aged ≥ 40 years who were newly diagnosed with psoriasis or AD between April 2012 and September 2022. Propensity score matching was used to balance age, sex, and baseline cardiovascular risk factors. The primary outcome was hospitalization for MACE, defined as myocardial infarction (MI) or stroke. Survival analyses were conducted, treating death as a competing risk. After 1:1 propensity score matching (n = 2208 per group), the mean age was 70 years. During a follow-up period (median 4.5 years for psoriasis and 4.4 years for AD), the incidence of MACE was 2.7% in both groups (hazard ratio 0.96, 95% confidence interval 0.67-1.38; p = 0.84). When analyzed separately, the risks of MI and stroke did not differ significantly between groups. Results were consistent across subgroups by psoriasis severity and in two sensitivity analyses. We observed no excess risk of MACE in Japanese patients with psoriasis compared with those with AD over a median follow-up of approximately 4.5 years. These findings suggest that the cardiovascular risk specifically attributable to psoriasis may be limited in the Japanese population.