Page 11 - Vasoclick emagazine Issue2

Vasoclick, Edition 2 10

Systematic Review & Meta-analysis

Association of Psoriasis with Incident Venous Thromboembolism and Peripheral
Vascular Disease

Endorsed by: Dr. Rajesh Hyderabadi, Cardio-Thoracic Surgeon, Ahmedabad.

Background

Psoriasis is a chronic inflammatory disease of the skin and increases the risk of cardiovascular
disease (CV) by 50%, rising further with skin severity. 1

Psoriasis shares similar inflammatory pathways and mechanisms as that of venous
thromboembolism (VTE) and peripheral vascular disease (PVD). 2

The previous meta-analyses that aimed to identify the association between them could not draw a
definitive conclusion due to the small number and cross-sectional nature of the studies included. 2

The current psoriasis guidelines discuss the cardiovascular comorbidities of psoriasis but
sufficient information is not available on its association with VTE and PVD. 3

The comprehensive meta-analysis study by Chen et al aims to compile and review the current
inconsistent evidence on the association of psoriasis with VTE and PVD to provide a better

understanding of the outcomes of recent studies. 2

Methods: associations of psoriasis with VTE or PVD.
This review and meta-analysis followed the Had an exposure group that had patients with

Meta-analysis of Observational Studies in psoriasis and a non-exposure group that had
Epidemiology (MOOSE) reporting guideline patients without psoriasis.
4
group19 and the Preferred Reporting Items for Reported the risk estimates of VTE and/or
Systematic Reviews and Meta-analyses PVD.

(PRISMA) reporting 2020 guideline. Studies with confirmed clinical diagnoses of
5
psoriasis, VTE, and PVD.

Data Sources:
MEDLINE, Embase, Cochrane Library, Web of Studies excluded:

Science, and the Cumulative Index to Nursing Cross-sectional studies, case-control studies,
and Allied Health Literature were searched for case reports, editorials, review articles, and

publications that studied the associations of nonhuman studies were excluded. 2
psoriasis with VTE or PVD from their

respective inception to May 21, 2021. 2 Data Extraction:
First author, year of publication, country,

Study Selection Criteria: database, study period, patient characteristics
Cohort studies that examined the (sample size, mean age, and sex), definition of

psoriasis, and outcomes of interest (VTE and There were 9 (69.2%) studies that reported The pooled risk estimates differed with incident VTE in patients with psoriasis but

PVD). 2 HR or SIR and were selected for quantitative geographic locations, with studies done in not in the US (Table 1).
2
The adjusted risk estimates, including hazard meta-analysis (Figure 1). Asia and Europe showing an increased risk of

ratios (HRs), risk ratios (RRs), and
standardized incidence ratios (SIRs), with 95%

confidence intervals (CIs). 2

Data Synthesis:
The meta-analyses were conducted using

Review Manager version 5.4.1 (The Cochrane
Collaboration), and Stata, version 17

(StataCorp). A P value of <0.05 was defined as
statistically significant. 2

HRs and SIRs were used for meta-analysis to
analyse risk for the entire study period. The

adjusted risk estimates of subgroups were
pooled when overall effects were not

available. 2
Crude risk estimates with 95% CI were

calculated when not available in the studies. 2
I statistic was used to quantify between-study Risk for Incident VTE:
2
heterogeneity with I >50% indicating moderate Based on the 9 studies (12,052,781
2
heterogeneity. 2 participants) examined, patients with

psoriasis had a 1.26-fold increased risk for
Results: incident VTE than those without psoriasis

Study Selection and their characteris- (pooled HR, 1.26; 95%, CI 1.08-1.48; I = 93%)
2
tics: (Figure 2). 2
A total of 1836 records were retrieved from

the literature search, 13 cohort studies The association remained significant in
(12,435,982 participants) out of which were patients with psoriatic arthritis but did not

selected for qualitative review (Figure 1). increase significantly in patients with
psoriasis alone (Table 1). 2

Out of the 13 studies selected, 9 (69.2%)
reported the risk estimates of incident VTE, The studies done on women showed an

and 4 (30.8%) reported the risk estimates of increased risk for VTE as opposed to those

incident PVD (Figure 1). done on men(Table 1). 2