OBJECTIVES: To evaluate the association between persistent use of statins and the risk of incident psoriasis among primary prevention patients in community settings. METHODS: A cohort of 205,820 adults aged >=21 years, with no indication of psoriasis or psoriatic arthritis, who began statin therapy between 1998 and 2009 in Maccabi Healthcare Services, a large health maintenance organization in Israel, was followed retrospectively for psoriasis. Persistence with statins was measured by the proportion of days covered (PDC) with dispensed prescriptions of statins during follow-up period. Psoriasis was counted if diagnosed by a dermatologist or at release from hospitalization. Sex-stratified Cox proportional hazards regression was used for analysis of risk of psoriasis by PDC level, adjusting for baseline demographic and clinical characteristics, initial statin efficacy and baseline use of beta-blockers. RESULTS: A total of 5160 cases of incident psoriasis were identified during the follow-up period (1.3 million person-years) with incidence density rate of 4.40/1,000PY (95% CI: 4.29-4.52). Multivariate analysis revealed a U-shaped association between persistence with statins and onset of psoriasis. In comparison with non-persistent users (