Association of Psoriasis With Incident Venous Thromboembolism and Peripheral Vascular Disease: A Systematic Review and Meta-analysis

Abstract

Importance: Psoriasis, venous thromboembolism (VTE), and peripheral vascular disease (PVD) share similar mechanisms involving chronic inflammation. However, the associations between psoriasis and VTE or PVD are unclear.

Objective: To determine the association of psoriasis with incident VTE and PVD.

Data sources: MEDLINE, Embase, Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for relevant publications from their respective inception through May 21, 2021. No restrictions on language or geographic locations were imposed.

Study selection: Two authors independently selected cohort studies that investigated the risk for incident VTE or PVD in patients with psoriasis. Any discrepancy was resolved through discussion with 2 senior authors until reaching consensus. Only 13 initially identified studies met the selection criteria for qualitative review, and only 9 of these for quantitative analysis.

Data extraction and synthesis: The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Two authors independently extracted data and assessed the risk of bias of included studies by using the Newcastle-Ottawa Scale. Disagreements were resolved by discussion with 2 other authors. A random-effects model meta-analysis was conducted to calculate the pooled hazard ratios (HRs) with the corresponding confidence intervals for incident VTE and PVD. Subgroup analyses based on arthritis status, psoriasis severity, sex, and geographic location were also performed.

Main outcomes and measures: Hazard ratios for incident VTE and PVD associated with psoriasis.

Results: A total of 13 cohort studies with 12 435 982 participants were included. The meta-analysis demonstrated 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) among patients with psoriasis. Subgroup analyses illustrated increased risk for incident VTE among participants with 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).

Conclusions and relevance: This systematic review and meta-analysis found an increased risk for incident VTE and PVD among patients with psoriatic disease. Typical presentations of VTE or PVD should not be overlooked in patients with psoriasis. 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.

Figure 1.. PRISMA Flow Diagram

CINAHL indicates Cumulative Index to Nursing and Allied Health Literature; PVD, peripheral vascular disease; VTE, venous thromboembolism.

Figure 2.. Summary of Risk of Bias Assessment

The blue minus circle denotes low risk of bias, question mark circle unclear risk of bias, and orange plus sign circle high risk of bias.

Figure 3.. Association of Psoriasis With Venous Thromboembolism (VTE) and Peripheral Vascular Disease (PVD)

The meta-analysis illustrated a significant association of psoriasis with VTE (hazard ratio, 1.26; 95% CI, 1.08-1.48) and PVD (hazard ratio, 1.27; 95% CI, 1.16-1.40). IV indicates inverse variance.