SGLT2 Inhibitors and Cardiovascular Outcomes in Patients With Moderate-to-Severe Psoriasis Receiving Biologic Therapy: A Propensity Score-Matched Cohort Study

BACKGROUND: Patients with moderate-to-severe psoriasis have an increased risk of cardiovascular disease. Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide cardiovascular benefits, but their association with cardiovascular outcomes in patients with psoriasis remains insufficiently studied. METHODS: We conducted a retrospective cohort study using the global TriNetX research network. Patients older than 40 years with plaque psoriasis receiving biologic therapy were categorized according to SGLT2 inhibitor use. Propensity score matching was performed to balance demographic characteristics, cardiovascular risk factors, kidney disease, and concomitant antidiabetic medications. RESULTS: After matching, 2016 patients were included in each cohort. SGLT2 inhibitor use was associated with a significantly lower incidence of acute myocardial infarction (HR, 0.601; 95%CI, 0.426-0.849), stroke (HR, 0.553; 95%CI, 0.381-0.804), heart failure (HR, 0.751; 95%CI, 0.581-0.970), peripheral artery disease (HR, 0.648; 95%CI, 0.470-0.894), and angina pectoris (HR, 0.601; 95%CI, 0.404-0.894). No significant association was observed for transient ischemic attack. CONCLUSIONS: SGLT2 inhibitor use was associated with favorable cardiovascular outcomes in patients with moderate-to-severe psoriasis receiving biologic therapy. These findings support further prospective investigation of SGLT2 inhibitors as a potential strategy for cardiovascular risk reduction in this population.