Patients With Psoriasis and Metabolic Syndrome Have Greater Inflammation, Risk for CVD

Patients with psoriasis and metabolic syndrome have more risk factors for cardiovascular disease (CVD) and greater systemic inflammation as well as coronary plaque burden than patients with psoriasis but without comorbid metabolic syndrome, according to study findings published in the Journal of the American Academy of Dermatology.

Participants with psoriasis (mean age, 50 years) from the ongoing longitudinal Psoriasis, Atherosclerosis, and Cardiometabolic Disease Initiative prospective study were included in this analysis. A total of 260 patients with psoriasis from the study who had coronary computed tomography angiography (CCTA) results and adequate data for classification of metabolic syndrome were enrolled.

Metabolic syndrome was defined as meeting3 or more of the harmonized IDF criteria, including waist circumference of greater than 102 cm for men or greater than 88 cm for women, triglycerides 150 mg/dL or greater, HDL-C less than 40 mg/dL for men or less than 50 mg/dL forwomen, systolic blood pressure 130 mmHg or greater, diastolic blood pressure85 mmHg or greater, or antihypertensive treatment in those with a history of hypertension, and fasting glucose 100 mg/dL or greater or the need for treatment of raised glucose.

Approximately 31% of the patients (n=80) with psoriasis met the criteria for metabolic syndrome. Patients with metabolic syndrome had a significantly higher burden of systemic inflammation by C-reactive protein levels (median, 2.4 vs 1.4; P =.02), noncalcified burden (mean, 1.4 vs 1.1; P <.001), coronary plaque (58% vs 38%; P =.01), and high-risk plaque (30% vs 15%; P =.02).

Patients with psoriasis and metabolic syndrome also had lower high-density lipoprotein cholesterol (median 44 vs 58; P <.001) and greater triglycerides (median, 148 vs 88; P <.001) compared with patients without metabolic syndrome.

In an analysis adjusted for Framingham risk score, lipid-lowering therapy, and biologic agent use, variables significantly associated with noncalcified coronary burden included metabolic syndrome (P <.001) as well as the syndrome’s individual components of waist circumference (P <.001), triglycerides (P =.005), blood pressure (P =.005), and fasting glucose (P =.009).

A limitation of this study included its observational and cross-sectional design, that the investigators said reduced their ability to control for potential confounders.

The researchers concluded that greater efforts “to increase metabolic syndrome awareness in psoriasis should be undertaken to reduce the associated heightened CVD risk.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Teklu M, Zhou W, Kapoor P, et al. Metabolic syndrome and its factors are associated with noncalcified coronary burden in psoriasis: An observational cohort study. Published online February 2, 2021. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.12.044