Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis

Abstract

The role of chronic inflammation causing metabolic and vascular disorders is increasingly recognized. It is hypothesized that proinflammatory cytokines contribute to atherogenesis, peripheral insulin resistance, and the development of hypertension and type II diabetes. Psoriasis as a chronic inflammatory skin disorder is characterized by a variety of immunologic and inflammatory changes and may similarly predispose for those disorders. The objective of this study was to elucidate the association of psoriasis with chronic vascular and metabolic disorders. We investigated a total of 581 adult patients hospitalised for plaque type psoriasis as compared to 1,044 hospital-based controls. A distinct pattern of chronic disorders was found to be significantly associated with psoriasis, including diabetes mellitus type II [odds ratio (OR)=2.48], arterial hypertension (OR = 3.27), hyperlipidemia (OR = 2.09), and coronary heart disease (OR = 1.95). The combined presence of these conditions together with obesity, known as the metabolic syndrome, was clearly more prevalent in psoriasis patients (OR = 5.29). In addition, psoriasis patients were significantly more likely to be smokers (OR = 2.96) and to have a regular or heavy consumption of alcohol (OR = 3.33 and 3.61, respectively). In conclusion, psoriasis patients appear to be at higher risk for diabetes mellitus and cardiovascular disease. This could likely be due to the effects of chronic inflammatory changes, in particular the secretion of proinflammatory cytokines. The risk of late term cardiovascular complications might support the use of systemic treatment in psoriasis.

National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening

“…14 However, others have demonstrated a lack of statistical significance, 60 especially after controlling for confounders such as smoking. 7,10 Moreover, most of these studies prove only an association between alcohol use and psoriasis, without demonstrating causality, 12,61,62 and it has also been argued that other patients with severe skin disease may experience the same problems. 61 …”

Psoriasis and Vascular Disease—Risk Factors and Outcomes: A Systematic Review of the Literature

“…Two well-designed studies of hospital-based adults with plaquetype psoriasis found higher rates of MBS beginning at middle age (40 to 49 years) and persisting throughout life. 51,54 In a study evaluating nearly 17,000 patients with psoriasis, the vast majority had components of MBS, and they had significantly higher prevalence of DM, HTN, and obesity as compared with controls. 55 Moreover, MBS was much more common in patients with psoriasis as compared to controls.…”

Molecular mechanisms of insulin resistance in chronic hepatitis C

“…High doses of aspirin and other salicylates inhibit IKKβ and can reduce IR in both rats and humans [58][59][60] . IR can similarly occur in other inflammatory conditions associated with elevated TNF-α, including inflammatory bowel disease [61] , rheumatoid arthritis [62] and psoriasis [63] .…”