Women with Psoriasis at Greater Risk for Metabolic Syndrome
Patients with psoriasis, especially women, are at an increased risk of developing metabolic syndrome, a cluster of heart disease risk factors. The disease which causes a thick scaly rash affects about 3% of Americans and is “more than skin deep” says study co-author Abrar Qureshi MD MPH of Brigham and Women’s Hospital Department of Dermatology.
Metabolic syndrome is defined as having at least three of the following risk factors for heart disease and diabetes: high blood pressure, abdominal obesity, high fasting blood sugar, low levels of HDL and high levels of triglycerides. Those with the condition are at a greater risk for heart attack, stroke, and peripheral vascular disease as well.
For the study, Dr. Qureshi and Dr. Thorvardur Jon Love MD of Landspitali Haskolasjukrahus in Iceland used data from the National Health and Nutrition Examination Survey (NHANES) of 2003-2006 which included more than 6,500 patients between the ages of 20 and 59. The prevalence of psoriasis in the cohort was 4%, with a mean age of 42 and BMI of 30 (considered obese).
Psoriasis patients were twice as likely to have the metabolic syndrome compared to the healthy controls, reports Dr. Love who published the findings in the Archives of Dermatology. BMI, waist circumference (abdominal obesity), and systolic blood pressure were measures that were significantly higher among those with psoriasis. Hypertriglyceridemia and low HDL levels were also common.
The prevalence of metabolic syndrome was higher among women with psoriasis than men with the disease.
Psoriasis is an autoimmune disease which is thought to be a manifestation of chronic, body-wide inflammation that causes an abnormal increase in skin cell turnover. Central obesity is also associated with inflammation, particularly in the markers TNF-alpha and interleukin 6, which may play a role in the pathogenesis of psoriasis.
But which condition comes first? Dr. Love says, “There’s evidence on both sides of the fence. There’s evidence that obesity drives the development of psoriasis. There’s also evidence that inflammation drives some components of insulin resistance. It’s a real chicken and egg problem at this point.”
However, because the conditions are obviously related, metabolic syndrome should be “recognized and taken into account in the long-term treatment of individuals with psoriasis,” conclude the authors. Weight loss through exercise and a healthy diet could benefit both conditions.
Love TJ, et al "Prevalence of the metabolic syndrome in psoriasis" Arch Derm 2010; DOI: 10.1001/archdermatol.2010.370.