Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 177-180  

Psoriasis and metabolic syndrome: Co-incidence or correlation


1 Department of Pathology, B. R. Singh Hospital, Eastern Railway, Sealdah, Kolkata, West Bengal, India
2 Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication1-Mar-2016

Correspondence Address:
Subhajit Das
Department of Pathology, B. R. Singh Hospital, Eastern Railway, Sealdah, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.167986

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  Abstract 

Background: Psoriasis is an immune-mediated chronic skin disease having effects on other organs. It has been linked to diabetes mellitus, hypertension, obesity, and dyslipidemia. All of these components ultimately increase the risk of metabolic syndrome and cardiovascular morbidities. Several studies have been done in the western world to identify the presence of metabolic syndrome (or its components) in psoriatic patients. Aims and Objectives: Our study had been done with the objective of identifying the prevalence of metabolic syndrome in psoriatics in comparison to normal population. Materials and Methods: The study was an institution-based case-control study. Subjects were recruited after obtaining informed consent. Cases of psoriasis were diagnosed clinically, and unrelated healthy volunteers served as controls. Inclusion criteria for cases were patients of clinically diagnosed psoriasis without any co-existent immune-suppressed conditions such as HIV, malignancy, or any other physiological conditions such as pregnancy or lactation that might influence metabolic syndrome. Smokers and alcoholics were also excluded from the study. Metabolic syndrome was defined by Adult treatment panel III criteria. Statistical Analysis: Descriptive statistics were expressed as range, mean ± standard deviation, frequencies (number of cases), and whichever was appropriate. For analytical statistics, numerical data were analyzed using t-test or ANOVA test, and for categorical data, Chi-square and Fischer's exact test were used. P ≤ 0.05 was considered as statistically significant. Results: Abdominal obesity (odds ratio [OR] = 2.6), hypertension (OR = 2.2), hyperglycemia (OR = 2.8), dyslipidemia (OR = 2.9), and metabolic syndrome (OR = 2.6) are associated with psoriasis. Conclusion: Psoriatic patients have an increased risk of developing abdominal obesity, hypertension, hyperglycemia, and dyslipidemia in comparison to general population. All these contribute to higher preponderance to metabolic syndrome.

Keywords: Diabetes mellitus, dyslipidemia, hypertension, metabolic syndrome, obesity, psoriasis


How to cite this article:
Das S, Manna A, Ahmad N, Banerjee D, Mondal S, Tayal P. Psoriasis and metabolic syndrome: Co-incidence or correlation. Med J DY Patil Univ 2016;9:177-80

How to cite this URL:
Das S, Manna A, Ahmad N, Banerjee D, Mondal S, Tayal P. Psoriasis and metabolic syndrome: Co-incidence or correlation. Med J DY Patil Univ [serial online] 2016 [cited 2020 May 27];9:177-80. Available from: http://www.mjdrdypu.org/text.asp?2016/9/2/177/167986


  Introduction Top


Psoriasis is an immune-mediated inflammatory skin disease with a variable prevalence across different geographical region of the world. The prevalence varies from 0.9% to 8.5%. [1] The disease is characterized by T-cell mediated hyperproliferation of keratinocytes, angiogenesis with vasodilatation and excess Th-1 and Th-17 mediated inflammatory processes based on a complex genetic background. [2],[3],[4]

Psoriasis has recently been shown to be associated with metabolic syndrome which is cluster of different comorbid conditions such as diabetes mellitus, hypertension, obesity and dyslipidemia, and a stronger predictor of cardiovascular diseases such as myocardial infarction. [5],[6] Major factors that may contribute to this unfavorable risk profile include cigarette smoking, alcoholism, obesity, physical inactivity, hyperhomocysteinemia, and psychological stress. These risk factors have been shown to be independently associated with metabolic syndrome. [7] Since last few years, many studies have been undertaken with the aim to identify the prevalence of metabolic syndrome in patients with psoriasis, but they are mostly limited to the western world. In eastern India, the association is not yet firmly established. So we had undertaken the study with the objectives of determining any association between psoriasis and metabolic syndrome (or its component).


  Materials and Methods Top


The study was an institution-based case-control study. Subjects were recruited after obtaining informed consent. Cases of psoriasis were diagnosed clinically, and unrelated healthy volunteers served as controls. Inclusion criteria for cases were patients of clinically diagnosed psoriasis without any co-existent immune-suppressed conditions such as HIV, malignancy, or any other physiological conditions such as pregnancy or lactation that might influence metabolic syndrome. Smokers and alcoholics were also excluded from the study. Metabolic syndrome was defined by Adult treatment panel III criteria as a presence of at least three of the following conditions: [8]

  • Abdominal obesity (waist circumference ≥102 cm in men, ≥88 cm in women).
  • Elevated serum triglycerides (≥150 mg/dl or under treatment).
  • Low high-density lipoprotein (HDL) cholesterol (men <40 mg/dl, women <50 mg/dl or under treatment).
  • Elevated blood pressure (≥130/85 mm of Hg or under treatment).
  • Elevated fasting blood sugar (FBS) (≥100 mg/dl or under treatment).


Statistical analysis

Descriptive statistics were expressed as range, mean ± standard deviation, frequencies (number of cases), and whichever was appropriate. For analytical statistics, numerical data were analyzed using t-test or ANOVA test, and for categorical data, Chi-square and Fischer's exact test were used. P ≤ 0.05 was considered as statistically significant.


  Results Top


One hundred and eleven patients of psoriasis and 162 healthy volunteers were screened during the study period of 36 months. The study population was mostly middle aged (psoriasis group 40.11 ± 16.30 years, control group 37.89 ± 12.68 years) with a male predominance (male:female ratio of 1:0.42 and 1:0.8 in psoriasis and control groups, respectively) [Table 1].
Table 1: Clinico-demographic profile of the study population

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The prevalence of abdominal obesity and hypertension among psoriasis cases were 16.2% and 20.7%, respectively. The values in control group were 6.8% and 10.5%, respectively. Both the findings were statistically significant (P < 0.05, Chi-square test) [Table 2]. The odds ratio (OR) for abdominal obesity and hypertension was 2.6 and 2.2, respectively.
Table 2: Status of parameters of metabolic syndrome in the study population

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The prevalence of raised FBS, elevated serum triglyceride, and low HDL cholesterol among psoriatic patients was found to be 29.7%, 27.1% and 24.3%, respectively. In control group, similar change in biochemical parameter was found to be 12.9%, 11.11%, and 9.2% of individuals, respectively, with significant intergroup difference (P > 0.05, Chi-square test) [Table 2]. The calculated OR for hyperglycemia and dyslipidemia was 2.8 and 2.9, respectively.

In total, 26 (23.4%) psoriatic patients and 17 (10.5%) controls had metabolic syndrome with significant intergroup differences (P = 0.006), and the OR was calculated to be 2.6.


  Discussion Top


Psoriasis is an immune-mediated inflammatory disease where genetic and environmental factors play significant roles in determining the clinical manifestations of psoriasis. Recently, it has been conceptualized that psoriasis is not merely a disease limited to skin and joints, rather it is a systemic inflammatory autoimmune disease that is connected with a range of co-morbidities. [5] This inflammatory nature of psoriasis is thought to predispose cardiovascular and metabolic disorders. Many studies have already evaluated the association of psoriasis and diabetes mellitus, obesity, dyslipidemias, and cardiovascular disorders. Unfortunately, most of them are limited to the western populations, and there is a paucity of Indian data in this regard. In our study, the association between psoriasis and MS was explored, and the results were compared with the previous studies.

Psoriasis and abdominal obesity

Abdominal obesity was present in 16.2% of the psoriatics and 6.8% of the controls. A significant association (P = 0.022) between abdominal obesity and psoriasis was derived, with an OR of 2.6. This finding is supported by a study conducted by Neimann et al. [9]

Psoriasis and hypertension

Hypertension was documented among 20.77% cases, which was significantly higher (P = 0.029) in comparison to control group. The OR in our study was 2.2., which was comparable with the studies of Neimann et al., [9] Sommer et al., [10] and Nisa and Qazi. [11]

Psoriasis and hyperglycemia

A significant association (P = 0.001) was found between hyperglycemia and psoriasis, in our study. About 29.7% of the cases had hyperglycemia compared to 12.9% of the controls. The OR of 2.8 of abnormal glucose homeostasis was obtained in psoriatics as compared to controls. Our observations are in accordance of the findings by Neimann et al., [9] Sommer et al., [10] Pereira et al., [12] and Nisa and Qazi. [11]

Psoriasis and dyslipidemia

Our observations revealed a strong association (P = 0.001) between psoriasis and dyslipidemia with an OR of 2.9. Similar observations were documented by Akhyani et al. [13] Sommer et al., [10] and Nisa and Qazi. [11]

Psoriasis and metabolic syndrome

Metabolic syndrome is cluster of risk factors including dyslipidemia, glucose intolerance, insulin resistance, central obesity, and hypertension and is a strong predictor of cardiovascular diseases, diabetes, and stroke. In studies conducted by Sommer et al. [10] and Nisa and Qazi., [11] higher prevalence of metabolic syndrome was seen in psoriatic patients. Our study also documented a strong association (P = 0.006) between psoriasis and metabolic syndrome, which is the answer to the higher cardiovascular comorbidities in psoriatics [Table 3].
Table 3: Literature review of association of psoriasis and metabolic syndrome

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  Conclusion Top


Psoriatic patients have an increased risk of developing abdominal obesity, hypertension, hyperglycemia, and dyslipidemia in comparison to general population. All these contribute to higher preponderance to metabolic syndrome and ultimately cardiovascular comorbidities.

Limitations

It would have been better if the genetically related first-degree relatives were included as controls. In that case, the risk/prevalence of metabolic syndrome in first-degree relatives would have been assessed.

 
  References Top

1.
Parisi R, Symmons DP, Griffiths CE, Ashcroft DM, Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) Project Team. Global epidemiology of psoriasis: A systematic review of incidence and prevalence. J Invest Dermatol 2013;133:377-85.  Back to cited text no. 1
    
2.
Bos JD, De Rie MA. The pathogenesis of psoriasis: Immunological facts and speculations. Immunol Today 1999; 20:40-6.  Back to cited text no. 2
    
3.
Krueger JG, Krane JF, Carter DM, Gottlieb AB. Role of growth factors, cytokines, and their receptors in the pathogenesis of psoriasis. J Invest Dermatol 1990;94:135-40.  Back to cited text no. 3
    
4.
Krueger JG, Bowcock A. Psoriasis pathophysiology: Current concepts of pathogenesis. Ann Rheum Dis 2005;64 Suppl 2:ii30-6.  Back to cited text no. 4
    
5.
Ninomiya JK, L′Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation 2004;109:42-6.  Back to cited text no. 5
    
6.
Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-9.  Back to cited text no. 6
    
7.
Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:2709-16.  Back to cited text no. 7
    
8.
Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C, American Heart Association, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433-8.  Back to cited text no. 8
    
9.
Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006;55: 829-35.  Back to cited text no. 9
    
10.
Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res 2006;298:321-8.  Back to cited text no. 10
    
11.
Nisa N, Qazi MA. Prevalence of metabolic syndrome in patients with psoriasis. Indian J Dermatol Venereol Leprol 2010;76:662-5.  Back to cited text no. 11
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12.
Pereira RR, Amladi ST, Varthakavi PK. A study of the prevalence of diabetes, insulin resistance, lipid abnormalities, and cardiovascular risk factors in patients with chronic plaque psoriasis. Indian J Dermatol 2011;56:520-6.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Akhyani M, Ehsani AH, Robati RM, Robati AM. The lipid profile in psoriasis: A controlled study. J Eur Acad Dermatol Venereol 2007;21:1330-2.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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