ReviewPsoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies
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
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Funding sources: None.
Conflicts of interest: None declared.
Reprints not available from the authors.