Risk of Major Adverse Cardiovascular Events (MACE) in Patients with Psoriasis

About the project

About the Project This PhD studentship is funded by a psoriasis association research grant. Background: Psoriasis is a chronic inflammatory skin disease associated with several comorbidities, including major adverse cardiovascular events (MACE), which are among the leading causes of death worldwide. Although some studies suggest that people with psoriasis have an increased risk of MACE compared with the general population, others have reported no significant association. The impact of systemic therapies, particularly biologics, on cardiovascular risk also remains uncertain. Biologic therapies for psoriasis have advanced considerably in recent years, with several highly effective agents now available. However, their long-term cardiovascular safety has not been fully established. Objectives: This project aims to address several knowledge gaps by: (1) Conducting a systematic review and meta-analysis to evaluate the risk of MACE in people with psoriasis; (2) Estimating the incidence and relative risk of MACE in people with psoriasis compared with the general population using the Secure Anonymised Information Linkage (SAIL) Databank; (3) Estimating the incidence and relative risk of MACE among people with moderate-to-severe psoriasis treated with biologic therapies using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR); (4) Identifying prognostic factors associated with the development of cardiovascular disease in people with psoriasis; (5) Assessing the performance of the general population cardiovascular risk prediction tool QRISK3 in people with psoriasis; (6) Developing and externally validating an extended version of QRISK3 tailored for people with psoriasis, using BADBIR for model development and the SAIL Databank for external validation. Methods Study 1: A systematic review and meta-analysis will synthesise the available peer-reviewed literature on cardiovascular disease (CVD) risk in people with psoriasis, incorporating evidence from both observational studies and randomised controlled trials. Study 2: A population-based study using the SAIL Databank will evaluate the incidence and risk of fatal and non-fatal MACE in people with psoriasis. The SAIL Databank contains linked, anonymised primary care and demographic data from Wales. Read codes will be used to identify both psoriasis cases and MACE outcomes. Study 3: A prospective cohort study using BADBIR will evaluate the incidence and risk of MACE, as well as the long-term cardiovascular safety of biologic treatments for psoriasis. BADBIR is a prospective registry with linkage to additional healthcare resources. Advanced statistical methods will be used to address biases commonly encountered in observational studies, including propensity score methods, competing risk analyses, and multiple imputation using chained equations. Study 4: This prediction study will evaluate the performance of an existing CVD risk prediction model and assess the benefit of extending it for use in people with psoriasis. BADBIR data will be used for model development, while the SAIL Databank will be used for external validation of the extended model to estimate 10-year cardiovascular disease risk. Funding Notes The Psoriasis Association PhD Studentship will commence in January 2027 and is funded for three years. The award covers tuition fees and provides an annual stipend in line with UKRI rates, with total funding of £100,000 (£33,334 in year one and £33,333 in years two and three). Environment: The PhD student will join a thriving research environment within the Division for Musculoskeletal and Dermatological Sciences, where the teaching and learning group has developed a set of core competencies for PhD students to ensure that as early career researchers, they are provided the necessary scientific and methodological training to become independent researchers. In addition to UoM provided courses on skills such as reviewing literature, writing a systematic review, time management during a PhD, presentation skills, and thesis writing, the Division provides topic specific training. These include regular scientific seminars, internal courses in epidemiology, biostatistics, and statistical software, as well as peer reviewing journal clubs and opportunities to present research. These courses will be particularly important for the advanced statistical techniques needed for this project, such as propensity score, and multiple imputation. Applicants are expected to hold (or about to obtain) a minimum upper second class undergraduate honours degree (or equivalent) in either Statistics, Medicine, Pharmacy. A Masters degree in a relevant subject and/or experience in Epidemiology / Biostatistics / Pharmacoepidemiology / Public Health is desirable. For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website ( https://www.bmh.manchester.ac.uk/study/research/apply/ ). Interested candidates must first make contact with the Primary Supervisor prior to submitting a formal application, to discuss their interest and suitability for the project. On the online application form select PhD Epidemiology . Equality, Diversity and Inclusion Equality, diversity and inclusion is fundamental to the success of The University of Manchester, and is at the heart of all of our activities. The full Equality, diversity and inclusion statement can be found on the website: Equality, diversity and inclusion (EDI | Postgraduate Research | Biology, Medicine and Health | University of Manchester

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