Psoriasis, an immune-mediated inflammatory disease, primarily involves the skin and joints and is common, impacting almost 8 million adults in the US. 1 Psoriasis can occur at any age, but incidence initially spikes in young adulthood and gradually increases in the following decades. 1 Psoriasis has emerged as one of the beststudied immune-mediated inflammatory diseases with respect to major cardiovascular (CV) events. A meta-analysis of 75 studies encompassing 500 000 patients with psoriasis observed CV disease as approximately 50% higher when compared to those without psoriasis. 1 Psoriasis is also associated with numerous cardiometabolic comorbidities. 1 However, large-scale epidemiological studies and carefully controlled CV imaging studies suggest psoriasis is associated with CV disease independent of traditional CV risk factors and in a doseresponse manner. 1 Within this context, Ramessur et al 2 conducted a 2-sample mendelian randomization study using variants from a large psoriasis genome-wide association study meta-analysis to investigate the relationship between genetic predictors of psoriasis and atherosclerotic cardiovascular disease (ASCVD). They found that while genetic predictors of psoriasis were not associated with enhanced ASCVD risk, genetic predictors of ASCVD, including coronary artery disease (CAD; odds ratio [OR], 1.07; 95% CI, 1.04-1.10) and stroke (OR, 1.22; 95% CI, 1.05-1.41), were associated with psoriasis. Genetic predictors of ASCVD were specifically associated with psoriasis and not other immune-mediated diseases examined, including asthma, multiple sclerosis, rheumatoid arthritis, atopic dermatitis, and inflammatory bowel disease.Their results are consistent with another mendelian randomization investigation describing shared systemic inflammatory pathways and a causal relationship of genetic predictors of CAD driving psoriasis but not of genetic predictors of psoriasis promoting CAD. 3 However, despite a strong statistical association of genetic susceptibility loci with psoriasis, the overall predictive value of these loci may be low given the modest association of these loci with psoriasis and the relatively low prevalence of psoriasis in the general population. 4 In other words, only a small proportion of the patients with the genetic instrument studied actually have psoriasis, and even fewer will have moderate to severe psoriatic disease, in which the most clinically significant associations between psoriasis and ASCVD are observed.Regardless, there is now a series of mendelian randomization studies on psoriasis, which provide new insights into this complex relationship. For example, in contrast to Ramessur et al, 2 other mendelian randomization studies have ob-
