Patients With Psoriatic Disease May Have Greater Risk of VTE, PVD

Risk of venous thromboembolism (VTE) and peripheral vascular disease (PVD) may be greater in patients with psoriasis, particularly women and those with concomitant psoriatic arthritis. Results were published recently in JAMA Dermatology.

As 2 vascular diseases associated with serious systemic effects, VTE and PVD have been shown to have a pathophysiology marked by chronic inflammation. Notably, activated immune responses in psoriasis may contribute to vascular inflammation and subsequent atherosclerosis.

“Regarding the current psoriasis guidelines, little is known about whether psoriasis might be associated with VTE or PVD apart from most cardiovascular comorbidities of psoriasis,” noted the researchers.

Citing inconsistent findings of previous studies, they conducted a systematic review and meta-analysis of relevant literature on the association between psoriasis and VTE and PVD derived from MEDLINE, Embase, Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature from inception to May 21, 2021.

Researchers followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline, in which only 13 initially identified studies, 9 for VTE and 4 for PVD, met the selection criteria for qualitative review (N = 12,435,982 participants).

A random-effects model meta-analysis was conducted to calculate risk for incident VTE and PVD, with subgroup analyses additionally performed based on arthritis status, psoriasis severity, sex, and geographic location.

Of the studies included in the meta-analysis, 9 met criteria for quantitative analysis (n = 12,052,781). Compared with those without psoriasis, patients with psoriasis exhibited a significantly increased risk for incident VTE (pooled HR, 1.26; 95% CI, 1.08-1.48) and PVD (pooled HR, 1.27; 95% CI, 1.16-1.40).

Furthermore, subgroup analyses of participants with psoriasis showed increased risk for incident VTE among patients with concomitant psoriatic arthritis (pooled HR, 1.24; 95% CI, 1.01-1.53), women (pooled HR, 1.89; 95% CI, 1.36-2.61), and those in Asia (pooled HR, 2.02; 95% CI, 1.42-2.88) and Europe (pooled HR, 1.28; 95% CI, 1.06-1.53).

“Physicians and patients with psoriasis should be aware of the risk of VTE and PVD,” concluded the researchers. “Typical presentations (eg, unexplained dyspnea, chest pain, and painful edematous swelling, as well as pulselessness and sensorimotor abnormalities of leg) should not be ignored by physicians who are treating patients with psoriasis.”

The study authors added that risk factors, such as obesity, physical inactivity, smoking, and varicose veins, should be identified and treated in patients with psoriasis, and medications like hormone-related therapies should be prescribed with caution.

Reference

Chen T-L, Lee L-L, Huang H-K, et al. Association of psoriasis with incident venous thromboembolism and peripheral vascular disease. JAMA Dermatol. Published online December 1, 2021. doi:10.1001/jamadermatol.2021.4918