Psoriasis Tied to Small Increase in Risk of Venous Thromboembolism, Peripheral Vascular Disease

By Linda Carroll

December 06, 2021

NEW YORK (Reuters Health) - Venous thromboembolism (VTE) and peripheral vascular disease (PVD) may be slightly more likely to develop among patients with psoriasis than those without the condition, a systematic review with meta-analysis suggests.

"Physicians and patients with psoriasis should be aware of the risk of VTE and PVD," the authors write in JAMA Dermatology.

"This systematic review and meta-analysis supplements the current psoriasis guideline on the awareness of cardiovascular comorbidities like venous thromboembolism (VTE) and peripheral vascular disease (PVD), which were not clarified before," said senior author Dr. Ching-Chi Chi of Chang Gun Memorial Hospital in Taoyuan, Taiwan. "Typical presentations of VTE and PVD should not be ignored by physicians approaching psoriatic patients (unexplained dyspnea, chest pain, and painful swelling as well as pulselessness and sensorimotor abnormalities of leg)," Dr. Chi told Reuters Health in an email.

"Our study also points out the importance of risk factor modification in patients with psoriasis. Risk factors, such as obesity, physical inactivity, smoking, and varicose veins, should be carefully followed or treated in patients with psoriasis, and medications like hormone-related therapies should be given with caution," Dr. Chi added.

To take a closer look at the risks of VTE and PVD in psoriasis patients, the researchers performed their quantitative review based on 13 studies (nine of VTE and four of PVD), while their meta-analysis was based on nine studies (seven of VTE and two of PVD).

Of the 13 cohort studies, including a total of more than 12 million participants, eight were conducted in Europe, four in North America, and one in Asia.

An analysis of the nine studies (12,052,781 participants) that explored a possible association between psoriasis and VTE revealed that psoriasis patients were at a 26% higher risk (95% confidence interval, 8% to 48%) of VTE than patients without the skin condition.

Based on the four studies (383,201 participants) that looked at PVD, psoriasis patients were at a 27% higher risk (95% CI, 16% to 40%) of the vascular disorder than patients who did not have the skin condition.

The researchers should be congratulated on their study since "the current literature on this topic has yielded disparate findings," said Dr. Tina Nandi, an assistant professor of dermatology at the Johns Hopkins University School of Medicine.

"It should be noted that VTE is generally quite rare," Dr. Nandi told Reuters Health by email. "One of the cited studies found the rate of VTE in patients with psoriasis was 37 in a study population of 38,608 (about 0.096%) patients, effectively less than 1/10 of a percent. Based on the findings in the current study, the expected rate of VTE in the general population is quite similar at, 7 in 10,000 (0.07%)."

"It has been previously reported and widely accepted that psoriasis represents a condition of chronic inflammation with significant association of cardiovascular comorbidities," Dr. Nandi said. "The finding that there is a slight increase in incidence of blood clots and peripheral vascular disease in psoriasis patients is not entirely surprising but should not be cause for alarm."

"One question left unanswered by this study is the relationship of psoriasis severity with risk of VTE and PVD," Dr. Nandi said. "The next logical question that we as a specialty should address is whether tighter control of psoriasis activity can mitigate the increased incidence of VTE and PVD. This might drive psoriasis patients to consider early and aggressive management of their skin disease."

While both dermatologists and primary-care physicians will acknowledge the value of addressing obesity, physical inactivity, and smoking among all patients, she added, it's important to recognize that "there is limited evidence to change practice regarding hormone therapy (like oral contraception) in psoriasis patients" and that "all patients should be counseled on the increased risk of blood clots with hormone therapy."

Dr. Chi did not respond to requests for comment.

SOURCE: JAMA Dermatology, online December 1, 2021.