Page 14 - Vasoclick emagazine Issue2

associations of psoriasis with VTE or PVD.
Methods:
Had an exposure group that had patients with
This review and meta-analysis followed the
psoriasis and a non-exposure group that had
Meta-analysis of Observational Studies in
patients without psoriasis.
Epidemiology (MOOSE) reporting guideline
4
Reported the risk estimates of VTE and/or
group19 and the Preferred Reporting Items for
PVD.
Reviews
Systematic
Meta-analyses
and
Studies with confirmed clinical diagnoses of
(PRISMA) reporting 2020 guideline.
5
psoriasis, VTE, and PVD.
Data Sources:
Studies excluded:
MEDLINE, Embase, Cochrane Library, Web of
Cross-sectional studies, case-control studies,
Science, and the Cumulative Index to Nursing
case reports, editorials, review articles, and
and Allied Health Literature were searched for
nonhuman studies were excluded.
publications that studied the associations of
psoriasis with VTE or PVD from their
Data Extraction:
respective inception to May 21, 2021.
2
First author, year of publication, country,
database, study period, patient characteristics
Study Selection Criteria:
(sample size, mean age, and sex), definition of
the
examined
Cohort
studies
that
Association of Psoriasis with Incident Venous Thromboembolism and Peripheral Vascular Disease 2 13
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 Subgroups No. of Studies Pooled HR (95% CI) P value
ratios (HRs), risk ratios (RRs), and Sex
standardized incidence ratios (SIRs), with 95% Men 2 1.40 (0.90-2.19) 0.13
confidence intervals (CIs). 2
Women 3 1.89 (1.36-2.61) * <0.001
Data Synthesis: Geographic Location
The meta-analyses were conducted using US 2 1.07 (0.67-1.70) 0.78
Review Manager version 5.4.1 (The Cochrane Asia 1 2.02 (1.42-2.88) * <0.001
Collaboration), and Stata, version 17
Europe 4 1.28 (1.06-1.53) * 0.01
(StataCorp). A P value of <0.05 was defined as
statistically significant. 2 Abbreviations: HR, hazard ratio; P < 0.05.
*
HRs and SIRs were used for meta-analysis to Risk for Incident PVD: 5) Vascular inflammation in arthritic psoriasis
analyse risk for the entire study period. The Meta-analysis of data from 4 studies that might account for the higher risk of
adjusted risk estimates of subgroups were (383,201participants) found a 1.27-fold higher incident VTE compared to psoriasis alone 2
pooled when overall effects were not risk of incident PVD in patients with psoriasis
available. 2 compared to patients without psoriasis (pooled Conclusion
Crude risk estimates with 95% CI were HR, 1.27; 95% CI, 1.16 - 1.40; I = 0%)(Figure 2). 2 Patients with psoriasis had a higher risk of
2

calculated when not available in the studies. 2 incident VTE and PVD compared to patients
I statistic was used to quantify between-study Risk for Incident VTE: Possible explanations for these findings can be who did not have psoriasis; especially in
2
heterogeneity with I >50% indicating moderate Based on the 9 studies (12,052,781 attributed to the following factors, as reported in women, patients with psoriatic arthritis, and
2
heterogeneity. 2 participants) examined, patients with psoriasis patients: patients from Asia and Europe. 2
psoriasis had a 1.26-fold increased risk for
Results: incident VTE than those without psoriasis 1) Increased levels of inflammatory (interleukin Different genetics and environment may alter
Study Selection and their characteris- (pooled HR, 1.26; 95%, CI 1.08-1.48; I = 93%) 17) and prothrombic markers also known to the risk of VTE in patients with psoriasis as
2
tics: (Figure 2). 2 contribute to cardiovascular diseases 6 observed in subgroup analysis. 2
A total of 1836 records were retrieved from
the literature search, 13 cohort studies The association remained significant in 2) Platelet activation and aggregation causing Physicians should note signs of VTE and
(12,435,982 participants) out of which were patients with psoriatic arthritis but did not coagulation and thromboembolic events 7 PVD like unexplained dyspnea, chest pain,
selected for qualitative review (Figure 1). increase significantly in patients with painful edematous swelling, pulselessness,

psoriasis alone (Table 1). 2
3) Atherosclerosis progression due to and sensorimotor abnormalities in patients
Out of the 13 studies selected, 9 (69.2%) excessive feed-forward amplification of with psoriasis and take caution in prescribing

reported the risk estimates of incident VTE, The studies done on women showed an inflammation and vascular dysfunction 8 hormone-related therapies for treatment.
2
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 4) Oxidative stress that can lead to thrombosis
and atherosclerosis 9