Key result
High-risk psoriasis patients lack cardiology consultation in ~57% of cases despite high cardiovascular risk.
Why the study?
Although guidelines recommend systematic CV risk assessment in psoriasis, how elevated CV risk translates into specialist escalation within coordinated healthcare systems remained unclear, and whether escalation occurs consistently in high-risk patients was unknown.
Cross-Sectional (n=10,331)
Despite near-universal primary care engagement, over half of cardiovascular high-risk psoriasis patients—and nearly a third of those with established cardiovascular disease—lack cardiology specialist consultation, with significant disparities affecting younger, female, and lower-income patients.
Background Psoriasis is associated with increased cardiovascular (CV) morbidity and premature mortality. Clinical guidelines recommend systematic CV risk assessment, yet how elevated CV risk translates into specialist escalation within coordinated healthcare systems remains unclear. In general practitioner-led models, referral to cardiology reflects progression beyond primary prevention. Whether escalation occurs consistently in CV high-risk patients is unknown. Purpose We evaluated cardiology consultation patterns among psoriasis-treated patients with CV risk in a structured healthcare system. We hypothesised that specialist escalation would increase with CV burden but remain heterogeneous across patient groups. Methods We conducted a population-based cross-sectional study using French regional health insurance reimbursement data (2023–2025). We identified adults treated for psoriasis using medication records. We defined cardiovascular risk factors (CVRFs) and established cardiovascular diseases (CVDs) using treatment and procedure codes over 24 months. We identified cardiology consultations from specialist billing claims. We used multivariable logistic regression to identify predictors of absent specialist consultation among CV high-risk patients engaged in primary care. Results Among 10,331 psoriasis- treated adults, 53.9% had at least one CVRF and 14.4% had established CVDs. Primary care engagement reached 97.5% among individuals with ≥1 CVRF. Overall, 57.4% of CV high-risk patients had no recorded cardiology consultation. Escalation increased with CV burden but remained incomplete: 35.4% of patients with three or more CVRFs and 30.4% of those with established CVDs had no recorded specialist involvement. Younger age, female sex and low-income coverage independently predicted absence of referral. Psoriasis treatment intensity did not influence escalation patterns. Conclusions Specialist escalation in CV high-risk psoriasis patients remains inconsistent despite near-universal primary care follow-up. Variation persists even in established CVDs and across demographic groups. Longitudinal evaluation is required to determine whether referral heterogeneity influences CV outcomes and prevention effectiveness.
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Mai et al. (2026) conducted a cross-sectional in Psoriasis with cardiovascular risk (n=10,331). Cardiovascular risk burden in psoriasis-treated adults was evaluated on Absence of recorded cardiology specialist consultation among CV high-risk patients. Cardiovascular high-risk status in psoriasis patients lacked cardiology consultation in 57.4% overall, 35.4% with ≥3 risk factors, and 30.4% with established CVD.
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