Psoriasis Carries an Increased Risk of Venous Thromboembolism: A Danish Nationwide Cohort Study

Abstract

BackgroundPsoriasis is an immunoinflammatory disease associated with cardiovascular risk factors, atherothrombotic events, and hypercoagulability. Venous thromboembolism (VTE) is potentially lethal and shares risk factors with psoriasis, but the risk of VTE associated with psoriasis is unknown. The present study investigated the potential association between psoriasis and VTE.Methods and FindingsInformation from nationwide prospectively recorded registers of hospitalization, drug dispensing from pharmacies, socio-economic data, and causes of death was linked on an individual level. In an unselected nationwide cohort, we used multivariate Poisson regression models controlling for age, gender, comorbidity, concomitant medication, socio-economic data, and calendar year, to assess the risk of VTE associated with psoriasis. A total of 35,138 patients with mild and 3,526 patients with severe psoriasis were identified and compared with 4,126,075 controls. Patients with psoriasis had higher incidence rates per 1000 person-years of VTE than controls (1.29, 1.92, and 3.20 for controls, mild psoriasis, and severe psoriasis, respectively). The rate ratio (RR) of VTE was elevated in all patients with psoriasis with RR 1.35 (95% confidence interval [CI] 1.21–1.49) and RR 2.06 (CI 1.63–2.61) for mild and severe psoriasis, respectively. Exclusion of patients with malignancies, and censoring of patients undergoing surgery did not alter the results.ConclusionThis nationwide cohort study indicates that patients with psoriasis are at increased risk of VTE. The risk was highest in young patients with severe psoriasis. Physicians should be aware that patients with psoriasis may be at increased risk of both venous and arterial thromboembolic events.

Is enhanced platelet activation the missing link leading to increased cardiovascular risk in psoriasis?

“…Though some reports such as Wakkee et al [20] indicate that there is no direct relationship between psoriasis and cardiovascular disease, the predominant view in a more recent report suggests that psoriasis patients are prone to have increased cardiometabolic risk factors [21]. Psoriatic patients have been found to be at increased risk for occlusive vascular diseases such as atherosclerosis, coronary artery disease and cerebrovascular diseases [21].…”

“…Tamagawa-Mineoka et al also showed increased plasma P-selectin concentrations in psoriatic patients which resolved with treatment [34,35]. There are also studies that show significant correlation of plasma P-selectin expression by flow cytometry with disease severity, with both improving on treatment [21,36]. Pselectin concentrations assume importance as it plays multiple proinflammatory roles, mediating adhesion and rolling of immune cells on adherent platelets and release of platelet derived chemokines, known to cause development of atherosclerosis [37].…”

Interleukin 6 regulates psoriasiform inflammation–associated thrombosis

“…Psoriasis patients are at an increased risk of developing and dying of a cardiovascular event (7)(8)(9)(10)(11). A potential pathogenic role for MRP8/14 in psoriasis is supported by the finding that MRP8/14 genes are located within the psoriasis PSORS4 susceptibility region (12), and that serum and skin MRP8/14 levels are increased in psoriasis and psoriatic arthritis patients (13,14) and in psoriasiform mouse models (15)(16)(17).…”

Renal Infarction in a Patient with Psoriasis: Case Report

“…12 Yaş, cinsiyet, eşlik eden başka hastalıklar, ilaç kullanımı, sosyoekonomik durum ve hastalık süresi gibi birçok değişkeni içeren Poisson regresyon analizi kullanılarak yapılan, geriye dönük, geniş çaplı, vaka-kontrollü kohort çalışmasında, psöriyazisli tüm hastalarda venöz tromboemboli riskinin normal popülasyona göre istatiksel olarak anlamlı derecede arttığı (RR 1.35), özellikle genç ve ciddi psöriyazisli olguların ise venöz tromboemboli açısından çok yüksek risk taşıdığı saptanmıştır. 12 Ayrıca psöriyazisli olgularda plazma folik asit ve B12 vitamini düzeyleri normal toplumdakine göre daha düşük ve serum homosistein düzeyleri daha yüksek bulunmuştur. 13 Sunulan olguda da homosistein düzeyi sınırda ve folik asit düzeyi düşüktür.…”

“…15,16 Bu nedenle, psöriyazisli hastalarda hem arteryel hem de venöz tromboembolik olaylar açısından dikkatli olunmalıdır. 12 Sol böğür ağrısı şikâyeti ile başvuran erişkin psöriyazisli bu olgumuzda, hematüri ve yüksek serum LDH düzeyi saptanmasıyla renal infarktüsten şüphelenilmiş, arteryel tromboza neden olabilecek çevresel ve genetik etkenler, aile anamnezi ve eşlik eden venöz tromboemboli varlığı araştırılmış, sigara kullanma ve psöriyazis hastalığı dışında ek bir predispozan faktör tespit edilememiştir.…”