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

  • Dorothea M. Sommer
  • Stefan Jenisch
  • Michael Suchan
  • Enno Christophers
  • Michael Weichenthal
Original Paper

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), hyperlipedemia (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.

Keywords

Inflammation Clinical epidemiology Insulin resistance syndrome Comorbidity 

References

  1. 1.
    Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part: 1 diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15(7):539–553PubMedCrossRefGoogle Scholar
  2. 2.
    Bloomgarden ZT (2004) Definitions of the insulin resistance syndrome: the 1st World Congress on the insulin resistance syndrome. Diabetes Care 27(3):824–830PubMedGoogle Scholar
  3. 3.
    Choi HK, Hernan MA, Seeger JD, Robins JM, Wolfe F (2002) Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 359(9313):1173–1177PubMedCrossRefGoogle Scholar
  4. 4.
    Dessein PH, Joffe BI, Stanwix AE (2003) Inflammation, insulin resistance, and aberrant lipid metabolism as cardiovascular risk factors in rheumatoid arthritis. J Rheumatol 30(7):1403–1405PubMedGoogle Scholar
  5. 5.
    Fernandez-Real JM, Ricart W (2003) Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev 24(3):278–301PubMedCrossRefGoogle Scholar
  6. 6.
    Gladman DD, Farewell VT, Rahman P, Schentag CT, Pellett F, Ng CM, Wade JA (2001) HLA-DRB1*04 alleles in psoriatic arthritis: comparison with rheumatoid arthritis and healthy controls. Hum Immunol 62(11):1239–1244PubMedCrossRefGoogle Scholar
  7. 7.
    Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C (2004) Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 109(3):433–438PubMedCrossRefGoogle Scholar
  8. 8.
    Gudjonsson JE, Karason A, Antonsdottir AA, Runarsdottir EH, Gulcher JR, Stefansson K, Valdimarsson H (2002) HLA-Cw6-positive and HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical features. J Invest Dermatol 118(2):362–365PubMedCrossRefGoogle Scholar
  9. 9.
    Henseler T, Christophers E (1995) Disease concomitance in psoriasis. J Am Acad Dermatol 32:982–986PubMedCrossRefGoogle Scholar
  10. 10.
    Kendall DM, Sobel BE, Coulston AM, Peters Harmel AL, McLean BK, Peragallo-Dittko V, Buse JB, Fonseca VA, Hill JO, Nesto RW, Sunyer FX (2003) The insulin resistance syndrome and coronary artery disease. Coron Artery Dis 14(4):335–348PubMedCrossRefGoogle Scholar
  11. 11.
    Kiortsis DN, Mavridis AK, Vasakos S, Nikas SN, Drosos AA (2005) Effects of infliximab treatment on insulin resistance in patients with rheumatoid arthritis and ankylosing spondylitis. Ann Rheum Dis 64(5):765–766PubMedCrossRefGoogle Scholar
  12. 12.
    Lindegard B (1986) Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica 172:298–304PubMedCrossRefGoogle Scholar
  13. 13.
    Mallbris L, Akre O, Granath F, Yin L, Lindelof B, Ekbom A, Stahle-Backdahl M (2004) Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients. Eur J Epidemiol 19(3):225–230PubMedCrossRefGoogle Scholar
  14. 14.
    Mallbris L, Granath F, Hamsten A, Stahle M (2006) Psoriasis is associated with lipid abnormalities at the onset of skin disease. J Am Acad Dermatol 54(4):614–621PubMedCrossRefGoogle Scholar
  15. 15.
    McDonald CJ (1989) Cardiovascular disease in psoriasis. J Invest Dermatol 92:646–647PubMedCrossRefGoogle Scholar
  16. 16.
    McDonald CJ, Calabresi P (1978) Psoriasis and occlusive vascular disease. Br J Dermatol 99(5):469–475PubMedCrossRefGoogle Scholar
  17. 17.
    Moll JM, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3(1):55–78PubMedCrossRefGoogle Scholar
  18. 18.
    Montagnani A, Tosti A, Patrizi A, Salardi S, Cacciari E (1985) Diabetes mellitus and skin diseases in childhood. Dermatologica 170:65–68PubMedCrossRefGoogle Scholar
  19. 19.
    Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, Rossi E, Marinaro P, Polenghi MM, Finzi A et al (1992) Family history, smoking habits, alcohol consumption and risk of psoriasis. Br J Dermatol 127:212–217PubMedCrossRefGoogle Scholar
  20. 20.
    Offidani A, Cellini A, Valeri G, Giovagnoni A (1998) Subclinical joint involvement in psoriasis: magnetic resonance imaging and x-ray findings. Acta Derm Venereol 78:463–465PubMedCrossRefGoogle Scholar
  21. 21.
    Poikolainen K, Reunala T, Karvonen J, Lauharanta J, Karkkainen P (1990) Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 300:780–783PubMedCrossRefGoogle Scholar
  22. 22.
    Prodanowich S, Ma F, Taylor JR, Pezon C, Fasihi T, Kirsner RS (2005) Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis. J Am Acad Dermatol 52(2):262–267PubMedCrossRefGoogle Scholar
  23. 23.
    Rotter V, Nagaev I, Smith U (2003) Interleukin-6 (IL-6) induces insulin resistance in 3T3-L1 adipocytes and is, like IL-8 and tumor necrosis factor-alpha, overexpressed in human fat cells from insulin-resistant subjects. J Biol Chem 278(46):45777–45784PubMedCrossRefGoogle Scholar
  24. 24.
    Sattar N, McCarey DW, Capell H, McInnes IB (2003) Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation 108(24):2957–2963PubMedCrossRefGoogle Scholar
  25. 25.
    Stern RS, Lange R (1988) Cardiovascular disease, cancer, and cause of death in patients with psoriasis: 10 years prospective experience in a cohort of 1,380 patients. J Invest Dermatol 91:197–201PubMedCrossRefGoogle Scholar
  26. 26.
    Vasku V, Kankova K, Vasku A, Muzik J, Izakovicova Holla L, Semradova V, Vacha J (2002) Gene polymorphisms (G82S, 1704G/T, 2184A/G and 2245G/A) of the receptor of advanced glycation end products (RAGE) in plaque psoriasis. Arch Dermatol Res 294(3):127–130PubMedCrossRefGoogle Scholar
  27. 27.
    Winchester R (1993) Psoriatic arthritis. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF (eds) Dermatology in general medicine, 4th edn. McGraw-Hill Book Company, New York, pp 515–527Google Scholar
  28. 28.
    Zachariae H (2003) Prevalence of joint disease in patients with psoriasis: implications for therapy. Am J Clin Dermatol 4(7):441–447PubMedCrossRefGoogle Scholar
  29. 29.
    Zachariae H, Zachariae R, Blomqvist K, Davidsson S, Molin L, Mork C, Sigurgeirsson B (2002) Quality of life and prevalence of arthritis reported by 5,795 members of the Nordic Psoriasis Associations. Data from the Nordic Quality of Life Study. Acta Derm Venereol 82(2):108–113PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Dorothea M. Sommer
    • 1
  • Stefan Jenisch
    • 2
  • Michael Suchan
    • 1
  • Enno Christophers
    • 1
  • Michael Weichenthal
    • 1
  1. 1.Department of DermatologyUniversity of KielKielGermany
  2. 2.Department of ImmunologyUniversity of KielKielGermany

Personalised recommendations