{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:25:09Z","timestamp":1782138309763,"version":"3.54.5"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Konkuk University Medical Center Research Grant 2020","award":["202001"],"award-info":[{"award-number":["202001"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This nationwide population-based cohort study aimed to investigate the impact of systemic anti-inflammatory treatment on the major adverse cardiovascular events (MACE) risk in patients with psoriasis from January 2006 to December 2018, using a database provided by the Korean National Health Insurance Service. Patients were grouped based on the following treatment modalities: biologics, phototherapy, methotrexate, cyclosporine, and mixed conventional systemic agents. Patients who had not received any systemic treatment were assigned to the control cohort. The incidence of MACE per 1000 person-year was 3.5, 9.3, 12.1, 28.4, 39.5, and 14.5 in the biologic, phototherapy, methotrexate, cyclosporine, mixed conventional systemic agents, and control cohorts, respectively. During the 36-month follow-up, the cumulative incidence of MACE in the phototherapy and biologic cohorts remained lower than that of other treatment modalities. Cyclosporine (hazard ratio (HR)\u2009=\u20092.11, 95% confidence interval (CI)\u2009=\u20091.64\u20132.71) and mixed conventional systemic agents (HR\u2009=\u20092.57, 95% CI\u2009=\u20092.05\u20133.22) treatments were associated with increased MACE risk. Methotrexate treatment was not associated with MACE. Our finding demonstrates that treatment modalities may affect cardiovascular comorbidities in patients with psoriasis. Thus, an appropriate combination of anti-psoriatic therapies should be considered to manage patients with high cardiovascular risk.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>IRB approval status<\/jats:italic>\n                    : Waiver decision was obtained by the institutional review board, Konkuk University Hospital, Seoul, Republic of Korea (KUH1120107).\n                  <\/jats:p>","DOI":"10.1038\/s41598-021-87766-y","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T06:19:00Z","timestamp":1618985940000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["The potential impact of systemic anti-inflammatory therapies in psoriasis on major adverse cardiovascular events: a Korean nationwide cohort study"],"prefix":"10.1038","volume":"11","author":[{"given":"Joo Ran","family":"Hong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hojin","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeongsu","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Suk","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Youn","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Min","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Ah","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang Won","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Beom","family":"Choe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu Joong","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"key":"87766_CR1","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.jaad.2008.09.022","volume":"60","author":"SK Kurd","year":"2009","unstructured":"Kurd, S. K. & Gelfand, J. M. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003\u20132004. J. Am. Acad. Dermatol. 60, 218\u2013224. https:\/\/doi.org\/10.1016\/j.jaad.2008.09.022 (2009).","journal-title":"J. Am. Acad. Dermatol."},{"key":"87766_CR2","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1111\/bjd.14557","volume":"175","author":"MK Rutter","year":"2016","unstructured":"Rutter, M. K. et al. Primary care-based screening for cardiovascular risk factors in patients with psoriasis. Br. J. Dermatol. 175, 348\u2013356. https:\/\/doi.org\/10.1111\/bjd.14557 (2016).","journal-title":"Br. J. Dermatol."},{"key":"87766_CR3","doi-asserted-by":"publisher","first-page":"e000062","DOI":"10.1161\/JAHA.113.000062","volume":"2","author":"EJ Armstrong","year":"2013","unstructured":"Armstrong, E. J., Harskamp, C. T. & Armstrong, A. W. Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies. J. Am. Heart Assoc. 2, e000062. https:\/\/doi.org\/10.1161\/JAHA.113.000062 (2013).","journal-title":"J. Am. Heart Assoc."},{"key":"87766_CR4","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jaad.2016.07.064","volume":"76","author":"J Takeshita","year":"2017","unstructured":"Takeshita, J. et al. Psoriasis and comorbid diseases: epidemiology. J. Am. Acad. Dermatol. 76, 377\u2013390. https:\/\/doi.org\/10.1016\/j.jaad.2016.07.064 (2017).","journal-title":"J. Am. Acad. Dermatol."},{"key":"87766_CR5","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1111\/j.1365-2133.2008.08707.x","volume":"159","author":"JA Kaye","year":"2008","unstructured":"Kaye, J. A., Li, L. & Jick, S. S. Incidence of risk factors for myocardial infarction and other vascular diseases in patients with psoriasis. Br. J. Dermatol. 159, 895\u2013902. https:\/\/doi.org\/10.1111\/j.1365-2133.2008.08707.x (2008).","journal-title":"Br. J. Dermatol."},{"key":"87766_CR6","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1111\/j.1365-2133.2008.09020.x","volume":"160","author":"YB Brauchli","year":"2009","unstructured":"Brauchli, Y. B., Jick, S. S., Miret, M. & Meier, C. R. Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case-control analysis. Br. J. Dermatol. 160, 1048\u20131056. https:\/\/doi.org\/10.1111\/j.1365-2133.2008.09020.x (2009).","journal-title":"Br. J. Dermatol."},{"key":"87766_CR7","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1038\/nri1882","volume":"6","author":"GK Hansson","year":"2006","unstructured":"Hansson, G. K. & Libby, P. The immune response in atherosclerosis: a double-edged sword. Nat. Rev. Immunol. 6, 508\u2013519. https:\/\/doi.org\/10.1038\/nri1882 (2006).","journal-title":"Nat. Rev. Immunol."},{"key":"87766_CR8","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1177\/0003319716652284","volume":"68","author":"BG Choi","year":"2017","unstructured":"Choi, B. G. et al. Assessment of arterial stiffness in Korean patients with psoriasis by Cardio-Ankle Vascular Index. Angiology 68, 608\u2013613. https:\/\/doi.org\/10.1177\/0003319716652284 (2017).","journal-title":"Angiology"},{"key":"87766_CR9","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1111\/jdv.12768","volume":"29","author":"O Ahlehoff","year":"2015","unstructured":"Ahlehoff, O. et al. Cardiovascular outcomes and systemic anti-inflammatory drugs in patients with severe psoriasis: 5-year follow-up of a Danish nationwide cohort. J. Eur. Acad. Dermatol. Venereol. 29, 1128\u20131134. https:\/\/doi.org\/10.1111\/jdv.12768 (2015).","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"87766_CR10","first-page":"1002","volume":"16","author":"R Bissonnette","year":"2017","unstructured":"Bissonnette, R. et al. Evaluation of risk of major adverse cardiovascular events with biologic therapy in patients with psoriasis. J. Drugs Dermatol. 16, 1002\u20131013 (2017).","journal-title":"J. Drugs Dermatol."},{"key":"87766_CR11","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.3389\/fimmu.2018.01668","volume":"9","author":"G Caiazzo","year":"2018","unstructured":"Caiazzo, G. et al. Psoriasis, cardiovascular events, and biologics: lights and shadows. Front. Immunol. 9, 1668. https:\/\/doi.org\/10.3389\/fimmu.2018.01668 (2018).","journal-title":"Front. Immunol."},{"key":"87766_CR12","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.jaad.2013.09.020","volume":"70","author":"J Hugh","year":"2014","unstructured":"Hugh, J. et al. From the Medical Board of the National Psoriasis Foundation: the risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies. J. Am. Acad. Dermatol. 70, 168\u2013177. https:\/\/doi.org\/10.1016\/j.jaad.2013.09.020 (2014).","journal-title":"J. Am. Acad. Dermatol."},{"key":"87766_CR13","first-page":"300","volume":"11","author":"K Reich","year":"2012","unstructured":"Reich, K. et al. An update on the long-term safety experience of ustekinumab: results from the psoriasis clinical development program with up to four years of follow-up. J. Drugs Dermatol. 11, 300\u2013312 (2012).","journal-title":"J. Drugs Dermatol."},{"key":"87766_CR14","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1093\/cvr\/cvz009","volume":"115","author":"YA Elnabawi","year":"2019","unstructured":"Elnabawi, Y. A. et al. Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study. Cardiovasc. Res. 115, 721\u2013728. https:\/\/doi.org\/10.1093\/cvr\/cvz009 (2019).","journal-title":"Cardiovasc. Res."},{"key":"87766_CR15","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.jaad.2018.02.050","volume":"79","author":"JJ Wu","year":"2018","unstructured":"Wu, J. J. et al. The risk of cardiovascular events in psoriasis patients treated with tumor necrosis factor-alpha inhibitors versus phototherapy: an observational cohort study. J. Am. Acad. Dermatol. 79, 60\u201368. https:\/\/doi.org\/10.1016\/j.jaad.2018.02.050 (2018).","journal-title":"J. Am. Acad. Dermatol."},{"key":"87766_CR16","first-page":"1210","volume":"11","author":"KA Papp","year":"2012","unstructured":"Papp, K. A. et al. PSOLAR: design, utility, and preliminary results of a prospective, international, disease-based registry of patients with psoriasis who are receiving, or are candidates for, conventional systemic treatments or biologic agents. J. Drugs Dermatol. 11, 1210\u20131217 (2012).","journal-title":"J. Drugs Dermatol."},{"key":"87766_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1365-2133.2009.09281.x","volume":"161","author":"AB Alexandroff","year":"2009","unstructured":"Alexandroff, A. B. et al. More than skin deep: atherosclerosis as a systemic manifestation of psoriasis. Br. J. Dermatol. 161, 1\u20137. https:\/\/doi.org\/10.1111\/j.1365-2133.2009.09281.x (2009).","journal-title":"Br. J. Dermatol."},{"key":"87766_CR18","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1007\/s40265-013-0173-5","volume":"74","author":"S Churton","year":"2014","unstructured":"Churton, S., Brown, L., Shin, T. M. & Korman, N. J. Does treatment of psoriasis reduce the risk of cardiovascular disease?. Drugs 74, 169\u2013182. https:\/\/doi.org\/10.1007\/s40265-013-0173-5 (2014).","journal-title":"Drugs"},{"key":"87766_CR19","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1016\/s0140-6736(02)11160-3","volume":"360","author":"E Rewald","year":"2002","unstructured":"Rewald, E. & de las Mercedes Francischetti, M. Methotrexate treatment and mortality in rheumatoid arthritis. Lancet 360, 1097. https:\/\/doi.org\/10.1016\/s0140-6736(02)11160-3 (2002).","journal-title":"Lancet"},{"key":"87766_CR20","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1016\/j.amjcard.2011.06.054","volume":"108","author":"R Micha","year":"2011","unstructured":"Micha, R. et al. Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease. Am. J. Cardiol. 108, 1362\u20131370. https:\/\/doi.org\/10.1016\/j.amjcard.2011.06.054 (2011).","journal-title":"Am. J. Cardiol."},{"key":"87766_CR21","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1136\/ard.2009.113696","volume":"69","author":"MJ Peters","year":"2010","unstructured":"Peters, M. J. et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann. Rheum. Dis. 69, 325\u2013331. https:\/\/doi.org\/10.1136\/ard.2009.113696 (2010).","journal-title":"Ann. Rheum. Dis."},{"key":"87766_CR22","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007893.pub2","author":"N Robert","year":"2010","unstructured":"Robert, N., Wong, G. W. & Wright, J. M. Effect of cyclosporine on blood pressure. Cochrane Database Syst. Rev. https:\/\/doi.org\/10.1002\/14651858.CD007893.pub2 (2010).","journal-title":"Cochrane Database Syst. Rev."},{"key":"87766_CR23","doi-asserted-by":"publisher","first-page":"500","DOI":"10.2174\/138161282004140213123505","volume":"20","author":"AW Armstrong","year":"2014","unstructured":"Armstrong, A. W., Brezinski, E. A., Follansbee, M. R. & Armstrong, E. J. Effects of biologic agents and other disease-modifying antirheumatic drugs on cardiovascular outcomes in psoriasis and psoriatic arthritis: a systematic review. Curr. Pharm. Des. 20, 500\u2013512. https:\/\/doi.org\/10.2174\/138161282004140213123505 (2014).","journal-title":"Curr. Pharm. Des."},{"key":"87766_CR24","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/0190-9622(92)70213-y","volume":"27","author":"MJ Stiller","year":"1992","unstructured":"Stiller, M. J. et al. Elevation of fasting serum lipids in patients treated with low-dose cyclosporine for severe plaque-type psoriasis. An assessment of clinical significance when viewed as a risk factor for cardiovascular disease. J. Am. Acad. Dermatol. 27, 434\u2013438. https:\/\/doi.org\/10.1016\/0190-9622(92)70213-y (1992).","journal-title":"J. Am. Acad. Dermatol."},{"key":"87766_CR25","doi-asserted-by":"publisher","first-page":"e12875","DOI":"10.1111\/dth.12875","volume":"32","author":"JR Hong","year":"2019","unstructured":"Hong, J. R., Lee, Y. W., Choe, Y. B. & Ahn, K. J. Risk factors for increased serum creatinine level in patients with psoriasis treated with cyclosporine in a real-world practice. Dermatol. Ther. 32, e12875. https:\/\/doi.org\/10.1111\/dth.12875 (2019).","journal-title":"Dermatol. Ther."},{"key":"87766_CR26","first-page":"772","volume":"10","author":"LK Dunn","year":"2011","unstructured":"Dunn, L. K., Gaar, L. R., Yentzer, B. A., O\u2019Neill, J. L. & Feldman, S. R. Acitretin in dermatology: a review. J. Drugs Dermatol. 10, 772\u2013782 (2011).","journal-title":"J. Drugs Dermatol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87766-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87766-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87766-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T01:54:40Z","timestamp":1670032480000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-87766-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,21]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["87766"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-87766-y","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-115540\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,21]]},"assertion":[{"value":"25 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Y.B.C. has received research grants from the the Konkuk University Medical Center. The remaining authors have no conflict of interest to declare.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8588"}}