Psoriasis is not a useful independent risk factor for cardiovascular disease.

Since Gelfand's 2006 publication, the hypothesis that psoriasis is a risk factor for myocardial infarction (MI) and cardiovascular disease (CVD) has drawn substantial attention (Gelfand et al., 2006). Makers of biologic therapies for psoriasis, whose products cost $15,000 to $25,000 per patient treated per year, are prominent sponsors of symposia and publications that have advanced this hypothesis (Strober et al., 2008; Friedewald et al., 2008). A company-supported clinical trial testing the hypothesis that tumor necrosis factor (TNF) inhibitor therapy of psoriasis may also reduce cardiovascular risk is under way (ClinicalTrials.gov, 2007). In this issue, Wakkee et al. provide additional evidence that it is unlikely that either psoriasis or severe psoriasis is a relevant risk factor for MI. Even if--after accounting for confounding and bias--psoriasis is significantly associated with CVD risk, psoriasis is unlikely to be a clinically useful independent risk factor for CVD.