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.
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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):539–553
Bloomgarden ZT (2004) Definitions of the insulin resistance syndrome: the 1st World Congress on the insulin resistance syndrome. Diabetes Care 27(3):824–830
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):1173–1177
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):1403–1405
Fernandez-Real JM, Ricart W (2003) Insulin resistance and chronic cardiovascular inflammatory syndrome. Endocr Rev 24(3):278–301
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):1239–1244
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):433–438
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):362–365
Henseler T, Christophers E (1995) Disease concomitance in psoriasis. J Am Acad Dermatol 32:982–986
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):335–348
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):765–766
Lindegard B (1986) Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica 172:298–304
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):225–230
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):614–621
McDonald CJ (1989) Cardiovascular disease in psoriasis. J Invest Dermatol 92:646–647
McDonald CJ, Calabresi P (1978) Psoriasis and occlusive vascular disease. Br J Dermatol 99(5):469–475
Moll JM, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3(1):55–78
Montagnani A, Tosti A, Patrizi A, Salardi S, Cacciari E (1985) Diabetes mellitus and skin diseases in childhood. Dermatologica 170:65–68
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 127:212–217
Offidani A, Cellini A, Valeri G, Giovagnoni A (1998) Subclinical joint involvement in psoriasis: magnetic resonance imaging and x-ray findings. Acta Derm Venereol 78:463–465
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 300:780–783
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):262–267
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):45777–45784
Sattar N, McCarey DW, Capell H, McInnes IB (2003) Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation 108(24):2957–2963
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 91:197–201
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):127–130
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 515–527
Zachariae H (2003) Prevalence of joint disease in patients with psoriasis: implications for therapy. Am J Clin Dermatol 4(7):441–447
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):108–113
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This work was supported by a German National Genome Research Network Grant (BMFT 01 GS 0171).
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Sommer, D.M., Jenisch, S., Suchan, M. et al. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res 298, 321–328 (2007). https://doi.org/10.1007/s00403-006-0703-z
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DOI: https://doi.org/10.1007/s00403-006-0703-z