Neutrophil‐to‐lymphocyte ratio as a cardiovascular risk biomarker in psoriasis: A comprehensive review

Abstract Background Psoriasis is a chronic and inflammatory cutaneous disease and it is associated with high cardiovascular risk (CVR). Studies have demonstrated that neutrophils may play a role in CVR in psoriasis. Neutrophil‐to‐lymphocyte ratio (NLR) is a readily available inflammatory biomarker that predicts the development of psoriasis and psoriatic arthritis and is associated with atherosclerosis and cardiovascular (CV) events. Objectives The aim of this review is to analyze the association between NLR and the presence or risk to develop cardiovascular disease (CVD) in psoriasis patients. Methods A comprehensive literature research was carried out through Pubmed, Embase and Web of Science to identify all the evidence related to NLR and CVD in psoriasis population. We enrolled all cohort, case‐control and cross‐sectional studies. Duplicated articles and papers without sufficient data were excluded after a full‐text review. Only articles published in English were enrolled in this study. Results primary searches identified 9 relevant articles. We included 1 observational, 5 case‐control and 3 cross‐sectional studies. NLR was assessed in all studies. As a whole, even though there is a paucity of published evidence, NLR was associated with an increased risk of subclinical atherosclerosis and CVD in all the articles included in this review. The main differences among studies were the sample size and the article design. Conclusion this review found that NLR is a simple, universally available and routine low‐cost biomarker able to predict CV events in patients with psoriasis. This test will help dermatologists to early detect those patients with psoriasis in whom there is a higher risk of CVD, who can benefit from preventive strategies and treatment settings.