Review
Psoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies

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Background

Increasing population-based studies have suggested a relationship between psoriasis and metabolic syndrome.

Objective

The objective of this study was to perform a systematic review and meta-analysis that synthesizes the epidemiologic associations between psoriasis and metabolic syndrome.

Methods

We searched for observational studies from MEDLINE, EMBASE, and Cochrane Central Register from Jan 1, 1980 to Jan 1, 2012. We applied the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines in the conduct of this study.

Results

We identified 12 observational studies with a total of 1.4 million study participants fulfilling the inclusion criteria, among whom 41,853 were patients with psoriasis. Based on random-effects modeling of cross-sectional and case-controlled studies, the pooled odds ratio (OR) for metabolic syndrome among patients with psoriasis was 2.26 (95% confidence interval [CI] 1.70-3.01) compared with the general population. Visual inspection of a funnel plot and formal analysis with the Egger test suggested publication bias and absence of small studies in the published literature (P = .03). A dose-response relationship was also observed between psoriasis severity and prevalence of metabolic syndrome.

Limitations

No studies to date have assessed incidence of metabolic syndrome among patients with psoriasis.

Conclusions

Compared with the general population, psoriasis patients have higher prevalence of metabolic syndrome, and patients with more severe psoriasis have greater odds of metabolic syndrome than those with milder psoriasis.

Introduction

Psoriasis is a chronic, inflammatory condition that affects approximately 1% to 3% of the general population.1, 2 During the past 10 years, population studies have found that patients with psoriasis may have increased prevalence of cardiovascular risk factors and elevated risk for developing adverse cardiovascular outcomes.3, 4, 5 A number of recent population-based studies have also suggested a relationship between psoriasis and metabolic syndrome.

Metabolic syndrome affects approximately 15% to 25% of the general population.6, 7 Specifically, it is a combination of disorders that, when occurring together, confer significantly elevated risk for development of subsequent cardiovascular disease that may be greater than the attributable risk of each component risk factor. Metabolic syndrome is thought to arise from insulin resistance and abnormal adipose tissue function.8

Various organizations have proposed criteria for the diagnosis of metabolic syndrome, including the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III),9, 10 the International Diabetes Foundation,11 the World Health Organization, and the European Group for the Study of Insulin Resistance. According to the updated NCEP ATP III from 2005,10 metabolic syndrome is diagnosed when a person has at least 3 of these 5 conditions: (1) fasting glucose 100 mg/dL or greater (or receiving drug therapy for hyperglycemia), (2) blood pressure 130/85 mm Hg or higher (or receiving drug therapy for hypertension), (3) triglycerides 150 mg/dL or higher (or receiving drug therapy for hypertriglyceridemia), (4) high-density lipoprotein-cholesterol complex (HDL-C) less than 40 mg/dL in men or less than 50 mg/dL in women (or receiving drug therapy for reduced HDL-C), and (5) waist circumference 102 cm (40 inches) or greater in men or 88 cm (35 inches) or greater in women; if Asian American, 90 cm (35 inches) or greater in men or 80 cm (32 inches) or greater in women.

Metabolic syndrome confers significant disease burden. For example, pooled data show that metabolic syndrome confers twice the risk for coronary artery disease,12 and it increases the risk of stroke, fatty liver disease, and certain types of malignancy.13 Recent literature suggests that psoriasis patients may have increased prevalence of metabolic syndrome. Current recommendations suggest that patients with psoriasis should be screened for metabolic syndrome, but the strength of this epidemiologic association has not previously been examined systematically.14 In this systematic review and meta-analysis, we aim to synthesize the literature on the association between psoriasis and metabolic syndrome from population-based studies.

Section snippets

Methods

We performed the systematic review using MEDLINE, EMBASE, and Cochrane Central Register. We used the following search criteria: (“Psoriasis” [MeSH]) AND “Metabolic Syndrome”[MeSH], limiting our search to English-language and human-subjects studies published between Jan 1, 1980 and Jan 1, 2012. All abstracts were read to determine eligibility for inclusion in the meta-analysis. To be included, original studies needed to fulfill the following inclusion criteria: case-control, cross-sectional,

Results

This systematic review and meta-analysis synthesized data from 12 studies with 1.4 million participants, among whom 41,853 were patients with psoriasis (Table I).21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 All studies were cross-sectional or case-control and assessed the prevalence of metabolic syndrome among patients with pre-existing psoriasis. Five of the 12 studies used the NCEP ATP III revised criteria to assess diagnosis of the metabolic syndrome, but the two largest studies used

Discussion

To our knowledge, this is the largest systematic review and the first meta-analysis examining the relationship between psoriasis and metabolic syndrome with 41,853 psoriasis patients from more than 1.4 million total participants. From the pooled OR from the meta-analysis, we found that psoriasis patients had increased odds of metabolic syndrome compared with the general population and that metabolic syndrome has a high prevalence among patients with psoriasis.

Several possible biologic

References (44)

  • S.M. Grundy

    Pre-diabetes, metabolic syndrome, and cardiovascular risk

    J Am Coll Cardiol

    (2012)
  • J.M. Gelfand et al.

    Prevalence and treatment of psoriasis in the United Kingdom: a population-based study

    Arch Dermatol

    (2005)
  • J.M. Gelfand et al.

    Risk of myocardial infarction in patients with psoriasis

    JAMA

    (2006)
  • N.N. Mehta et al.

    Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database

    Eur Heart J

    (2010)
  • A.A. Qureshi et al.

    Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses

    Arch Dermatol

    (2009)
  • E.S. Ford et al.

    Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey

    JAMA

    (2002)
  • G. Hu et al.

    Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women

    Arch Intern Med

    (2004)
  • R. Olufadi et al.

    Clinical and laboratory diagnosis of the metabolic syndrome

    J Clin Pathol

    (2008)
  • Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)

    JAMA

    (2001)
  • S.M. Grundy et al.

    Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement

    Circulation

    (2005)
  • The IDF consensus worldwide definition of the metabolic syndrome. International Diabetes Federation...
  • E. Giovannucci

    Metabolic syndrome, hyperinsulinemia, and colon cancer: a review

    Am J Clin Nutr

    (2007)
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    Funding sources: None.

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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