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Psoriasis associated with an increased risk of VTE and PVD

Patients with psoriasis are at an increased risk of developing venous thromboembolism (VTE) and peripheral vascular disease (PVD), suggesting a shared inflammatory mechanism. This was the conclusion of a retrospective analysis by researchers from the Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Psoriasis is an inflammatory disease and individuals have a 50% greater risk of cardiovascular disease and this risk further increases in those with more severe disease. Moreover, recent work has determined that in patients with psoriasis, there is enhanced inflammasome priming and activity which is increasingly linked with cardiovascular disease. Other work has shown how VTE is associated with inflammation and that PVD is linked to an increased cardiovascular mortality.

Taken together, these findings suggest a potential association between psoriasis and both VTE and PVD. Thus for the present study, the Taiwanese researchers aimed to assess the association between psoriasis with VTE and PVD. The team performed a systematic review and meta-analysis and included studies that examined studies in which patients had a confirmed diagnosis of psoriasis, VTE and PVD. The main outcome measures were hazard ratios for incident VTE and PVD associated with psorasis.

Findings

The team identified a total of 13 studies (9 VTE and 4 PVD) that enrolled 12,435,982 participants and which were suitable for inclusion in the analysis. The pooled hazard ratio, HR, for incident VTE was 1.26 (95% CI 1.08 – 1.48) among those with psoriasis compared to patients without the disease. Interestingly, the pooled risk for incident VTE was also higher in those with co-existing psoriatic arthritis (HR = 1.25, 95% CI 1.01 – 1.53), in women but not men (HR = 1.89) and among Asian (HR = 2.02) and European (HR = 1.28) patients.

Furthermore, there was a small, but significant increased risk of a VTE among those with mild psoriasis (HR = 1.07) and while the HR for severe disease was numerically higher (HR = 1.13), this was not statistically significant (p = 0.08).

A total of 4 studies with 383,201 individuals provided data on PVD and combining data showed a pooled HR of 1.27 (95% CI 1.16 0 1.40) compared with those without psoriasis.

The authors discussed how this increased risk of VTE and PVD should be considered by physicians and that it was important not to ignore the signs and symptoms of either vascular condition when treating those with psoriasis.

Citation

Chen TL et al. Association of Psoriasis With Incident Venous Thromboembolism and Peripheral Vascular Disease. A Systematic Review and Meta-analysis. JAMA Dermatol 2021



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