Bidirectional Pharmacological Interplay between Psoriasis and Cardiovascular Disease: A Systematic Review

Abstract Psoriasis and cardiovascular disease share inflammatory pathways, yet the bidirectional pharmacological interactions between their respective therapies remain incompletely characterised. This systematic review, conducted in accordance with PRISMA 2020 (OSF: osf.io/25uf9), synthesised evidence from 556 studies (5,378 records screened) on the effects of cardiovascular drugs on psoriasis and psoriasis therapies on cardiovascular outcomes. Dual independent screening, formal risk-of-bias assessment (RoB 2/ROBINS-I/AMSTAR 2), and GRADE certainty grading were employed. Observational studies linked beta-blockers (ROR 8.95), ACE inhibitors (OR 1.67), and thiazides (OR 1.23) to psoriasis onset; Mendelian randomisation estimates were near-null, compatible with confounding by indication. GLP-1 receptor agonists, statins, and PDE5 inhibitors carried anti-psoriatic signals. TNF-alpha inhibitors and methotrexate were associated with fewer major adverse cardiovascular events; IL-17 and IL-23 inhibitors showed neutral cardiovascular safety profiles. The synthesised evidence informed a risk-stratified treatment algorithm. GLP-1 receptor agonists, low-dose colchicine, and PDE5 inhibitors emerge as dual-target repurposing candidates meriting prospective evaluation.