Metabolic syndrome more common among people with psoriasis

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Almost half of people with psoriasis also have features of the metabolic syndrome, according to new study results.

Thorvardur Jon Love, MD, MMSc, of the Landspitali University Hospital in Reykjavik, Iceland, and colleagues from several U.S. sites, found that prevalence of the metabolic syndrome was nearly double among individuals with psoriasis compared to those without the skin disorder (40% vs. 23%; multivariate OR= 1.95; 95% CI: 1.01-3.77).

The association remained independent of factors including age, sex, race/ethnicity, smoking status and C-reactive protein levels.

“Given its associated serious complications, this comorbidity needs to be recognized and taken into account when treating individuals with psoriasis,” the researchers wrote. They noted that treating the metabolic syndrome should take precedent, as the disorder is “potentially more life threatening” than the skin condition.

Abdominal obesity (63%), high triglyceride levels (44% ≥150 mg per dL) and low levels of HDL cholesterol (34% <40 mg per dL in men; <50 mg per dL in women), were the most common metabolic syndrome features patients with psoriasis experienced.

The study cohort involved 6,549 people, aged 20 to 59 years, included in U.S. National Health and Nutrition Examination Survey from 2003 to 2006; 4% had psoriasis. Among those with psoriasis, the researchers found that age, BMI, waist circumference, and systolic blood pressure were all significantly higher (P=0.04, P=0.01, P=0.003, and P=0.02, respectively).

Lifestyle interventions including dietary modification and enhanced physical activity are the best ways to prevent metabolic syndrome, the researchers wrote, and may even “enhance the efficacy of psoriasis treatment.”

U.S. census data indicates that 6.6 million Americans have psoriasis, and approximately 2.7 million of those individuals also have the metabolic syndrome, the researchers projected, "an excess of one million patients compared with the expected value among individuals without psoriasis."

Abnormal inflammatory markers such as tumor necrosis factor-alpha and interleukin-6 are often associated with obesity, and the researchers suggested that these factors may help explain the pathogenesis of psoriasis.

“These data call for larger-scale studies to determine how individual treatment regimens affect the metabolic syndrome and cardiovascular disease risk in patients with psoriasis,” the researchers wrote. “Furthermore, it would also be valuable to study whether aggressive preventive treatment results in better cardiovascular-metabolic outcomes for patients with psoriasis.”

Full study results were published online first from the April 2011 issue of the Archives of Dermatology.
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