Prevalence of Metabolic Syndrome Increased in Persons With Psoriasis

Laurie Barclay, MD

December 21, 2010

December 21, 2010 — The prevalence of metabolic syndrome is increased in persons with psoriasis, according to results from the cross-sectional National Health and Nutrition Examination Survey (NHANES), 2003 to 2006, which were reported online December 20 and will be published in the April 2011 print issue of the Archives of Dermatology.

"Previous studies have suggested a link between psoriasis, a common inflammatory disorder, and individual components of the metabolic syndrome, such as obesity, hypertension, diabetes, and dyslipidemia," write Thorvardur Jon Love, MD, MMSc, from Landspitali University Hospital in Reykjavik, Iceland, and colleagues. "However, data on the association between psoriasis and the metabolic syndrome defined by a standard definition are scarce, as reflected in a recent review."

The study goal was to determine the approximate prevalence of the metabolic syndrome among individuals with psoriasis and to evaluate the association between these 2 conditions in a nationally representative random sample of the noninstitutionalized civilian US population.

Prevalence of the metabolic syndrome as defined by the revised National Cholesterol Education Program Adult Treatment Panel III was determined in 6549 NHANES participants aged 20 to 59 years. Mean age was 39 years, mean body mass index was 28 kg/m2, and half were men. After adjustment for age, sex, race/ethnicity, smoking status, and C-reactive protein levels, odds ratios (ORs) were calculated for associations between psoriasis and metabolic syndrome.

Among psoriasis cases, prevalence of metabolic syndrome was 40% compared with 23% among control participants. US census data in 2008 project that there were 2.7 million patients aged 20 to 59 years with both conditions. For patients with psoriasis and the metabolic syndrome, univariate OR was 2.16 (95% confidence interval [CI], 1.16 - 4.03), and multivariate OR was 1.96 (95% CI, 1.01 - 3.77).

Among patients with psoriasis, abdominal obesity was the most common feature of the metabolic syndrome (63%), followed by hypertriglyceridemia (44%) and low levels of high-density lipoprotein cholesterol (34%). No elements of the metabolic syndrome were present in 28% of individuals without psoriasis vs 13% of those with psoriasis.

"The prevalence of the metabolic syndrome is high among individuals with psoriasis," the study authors write. "Given the serious complications associated with the metabolic syndrome, this frequent comorbidity should be recognized and taken into account in the long-term treatment of individuals with psoriasis."

Limitations of this study include small subgroup sizes, reliance on self-reported diagnosis of psoriasis not validated with an examination by a dermatologist, and inability to determine temporal relationships.

"[T]hese findings from a nationally representative sample of US adults show a doubling in the prevalence of the metabolic syndrome among patients with psoriasis independent of age, sex, race/ethnicity, smoking status, and [C-reactive protein] levels," the study authors conclude. "These findings estimate that 2.7 million patients with psoriasis aged 20 to 59 years are affected by the metabolic syndrome."

The National Institutes of Health, the Psoriasis Foundation and the National Heart, Lung, and Blood Institute supported this study. One of the study authors (Dr. Gelfand) serves as a consultant to Amgen, Abbott, and Celgene; has received honoraria from Amgen, Abbott, Centocor, and Celgene; and has received grants from Amgen, Abbott, Pfizer, and Novartis.

Arch Dermatol. Published online December 20, 2010.

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