Improving Cardiometabolic Outcomes in the Psoriasis Cohort

Abstract

Psoriasis is a chronic inflammatory skin disease increasingly recognised as a systemic condition linked with elevated cardiometabolic risk. Despite strong evidence connecting psoriasis with adverse cardiovascular outcomes, this risk remains under-recognised in routine practice. This thesis addresses key knowledge and practice gaps among clinicians and patients, evaluates the cardiometabolic impact of systemic therapies, and tests a behavioural intervention designed to improve cardiovascular risk management in people with psoriasis.

The thesis incorporates peer-reviewed publications, including narrative and systematic reviews, retrospective cohort studies, cross-sectional surveys, and a randomised controlled trial. Early chapters examine clinician and patient perspectives, revealing limited awareness and suboptimal screening. Subsequent chapters report real-world analyses of biologic therapies and a systematic review and meta-analysis of major adverse cardiovascular events. A concise overview of systemic treatments highlights the limited evidence guiding therapy selection from a cardiovascular standpoint.

The final component presents the TEXTME PSO trial, which tested a mobile health intervention to support lifestyle modification and self-management. Baseline analyses and user feedback illustrate opportunities for patient-centred care and inform future prevention strategies.

Collectively, this work provides a multidimensional understanding of the psoriasis–cardiovascular disease interface, offering new insights into education, therapeutic impact, and prevention. The findings highlight the need for improved clinician education, routine cardiovascular risk assessment in dermatology, and scalable, patient-centred interventions for this high-risk population.