Risk of aortic aneurysm in patients with psoriasis: A systematic review and meta-analysis of cohort studies

Background The association between psoriasis and the risk of aortic aneurysm is still unclear. Hypothesis Patients with psoriasis have a higher risk of aortic aneurysm than healthy individuals. Methods PubMed, Embase, and Scopus from inception to 20 July 2019 were searched. We included cohort studies if they reported estimate effects on the risk of aortic aneurysm in patient with psoriasis. We used Newcastle-Ottawa Scale to evaluate methodology quality of eligible studies. Random-effect meta-analyses were used to estimate the overall risk. Subgroup analyses were conducted for analysis of influencing factors. Results After a view of 2207 citations, we included three large cohort studies enrolling 5 706 525 participants in this systematic review. Psoriasis patients have an increased risk of development of aortic aneurysm (hazard ratio [HR]: 1.30, 95%confidence intervals [CI], 1.10-1.55,I-2= 53.1%). The risk is not statistically different between patients with severe psoriasis (HR, 1.51, 95%CI, 1.04-2.19,I-2= 40.2%) and patients with mild psoriasis (HR, 1.24, 95%CI, 1.08-1.42,I-2= 24.1%). The risk was not statistically increased in female patients (HR, 1.55, 95%CI, 0.65-3.72), patients >= 50 years old (HR, 4.05, 95%CI, 0.69-23.75,I-2= 97.3%), and patients with diabetes (HR, 0.97, 95%CI, 0.83-1.14). Conclusions Current evidence from observational studies suggests that psoriasis increases the risk of aortic aneurysm, and screening of aortic aneurysm might be considered among psoriasis patients.