Coronary microvascular dysfunction may be prevalent among patients with severe psoriasis, according to a new study published by Piaserico et al in the Journal of Investigative Dermatology. Researchers assigned 503 patients with psoriasis who did not have clinical cardiovascular disease to undergo coronary microcirculation evaluation with transthoracic Doppler echocardiography. After excluding 55 of the patients as a result of incomplete data, 114 of 448 patients with psoriasis—31.5%—presented with coronary microvascular dysfunction. Additionally, patients who had a higher Psoriasis Area and Severity Index, longer disease duration, psoriatic arthritis, and hypertension had an increased risk of developing coronary microvascular dysfunction. Psoriasis severity and duration were found to be independently associated with reduced coronary flow reserve. The study authors emphasized that systemic inflammation may play a critical role in the development of coronary microvascular dysfunction, and coronary microcirculation may be an extracutaneous site involved in the immune-mediated injury of psoriasis. They concluded by recommending that physicians actively screen for coronary microvascular dysfunction in patients with severe psoriasis.