Abstract
Introduction: Psoriasis is a common dermatological disease that increases risk of cardiovascular disease. Previous studies have shown possible evidence that patients with psoriasis may also have increased risk of new-onset atrial fibrillation. Hypothesis: We assessed a hypothesis that psoriasis increases risk of atrial fibrillation by performing a systematic review and meta-analysis of prospective observational studies. Methods: A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through April 2016. The inclusion criterion was the prospective observational study that assessed risk of new-onset atrial fibrillation in adults with psoriasis. Outcome was the adjusted hazard ratio (HR) of atrial fibrillation comparing between patient with psoriasis and controls. Pooled HR and 95% confidence interval (CI) were calculated using a random-effects model. Results: The initial search yielded 176 articles. Fifteen articles underwent full-length review and data was extracted from 4 observational studies. All studies had prospective designs, involving totally 12,755 participants with a median follow-up time between 2.5 to 5 years. Psoriasis was identified by a medical code associated with clinic visits to a dermatologist. Incidence of atrial fibrillation was ascertained by cardiologist reviewed of electrocardiograms. There was a significant increased risk of new-onset atrial fibrillation in patients with psoriasis compared to controls with a pooled HR 1.42 (95%CI 1.22 -1.65, I 2 =68%). Conclusions: Our meta-analysis of prospective studies demonstrated that patient with psoriasis has increased risk of new-onset atrial fibrillation. Inflammation is likely an important factor in the pathophysiology of both atrial fibrillation and psoriasis. Future interventional studies addressing the impact of psoriasis treatment and prevention of atrial fibrillation should be performed.
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