Abstract Body (Do not enter title and authors here): Background:
Chronic inflammatory diseases are associated with a higher risk for atherosclerosis and adverse cardiovascular events. Psoriasis is a systemic inflammatory condition that significantly increases coronary artery disease risk. Subclinical atherosclerosis can be estimated by echocardiographic parameters like coronary flow velocity reserve (CFVR), diastolic peak flow velocity (DPFV), and hyperemic DPFV. Limited literature investigates these parameters in psoriasis, with inconsistent results.

Methods:
We systematically searched the major bibliographic databases including PubMed, Embase, Cochrane Library, and Google Scholar from inception to 7th May 2024 to retrieve relevant studies. The outcomes were pooled using the inverse variance random-effects model, and the results were presented as standardized mean difference (SMD) with the corresponding 95% confidence interval (CI).

Results:
4 studies with 557 participants (281: psoriasis and 276: controls) were included. The mean age of the psoriasis group was 44.7 ± 7.7 years and of the control group was 45.2 ± 5.9 years. Psoriasis patients had a significantly lower CFVR [SMD: -0.71; 95% CI: -0.97, -0.45; p<0.00001] and hyperemic DPFV [SMD: -0.71; 95% CI: -1.30, -0.12; p=0.02] compared to healthy controls. However, the difference between baseline DPFV was insignificant between the two groups [SMD: 0.20; 95% CI: -0.92, 1.32; p=0.73].

Conclusion:
This study demonstrates that psoriasis is associated with coronary microvascular disease as measured by significantly lower CFVR and hyperemic DPFV. These results suggest that impaired myocardial perfusion in psoriasis patients may be an early manifestation of cardiac involvement. Hence, early risk stratification in psoriasis patients is crucial. Further large, randomized trials are essential to corroborate the results of this meta-analysis.