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ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 13-16

Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case control study from a tertiary care center in Andhra Pradesh


1 Department of Dermatology, Venereology, Leprology, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
2 Department of Dermatology, Venereology, Leprology, NRI Medical College and Hospital, Guntur, Andhra Pradesh, India
3 Department of Dermatology, Venereology, Leprology, GSL Medical College and Hospital, Rajahmundry, Andhra Pradesh, India
4 Department of Dermatology, Venereology and Leprology, SMC, Vijayawada, Andhra Pradesh, India

Date of Web Publication18-Mar-2016

Correspondence Address:
Chintaginjala Aruna
Department of Dermatology, Venereology, Leprology, Katuri Medical College and Hospital, Chinakondrupadu, NH 16, Guntur - 522 019, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.178948

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  Abstract 

Background: Psoriasis is a chronic inflammatory disease of skin and joints affecting 1-3% of the population. Psoriasis may act as an external indicator of underlying immunological and metabolic dysregulation. Previous studies found higher prevalence of metabolic syndrome in patients with psoriasis, the former being a significant predictor of cardiovascular disease.
Aims: We aimed to study the prevalence of metabolic syndrome and its individual components in patients with psoriasis and to determine the relationship of disease duration and severity with metabolic syndrome.
Materials and Methods: A hospital-based comparative study was conducted involving 100 patients with psoriasis and 100 age- and sex-matched controls. Metabolic syndrome was diagnosed by the presence of three or more criteria of the National Cholesterol Education Program Adult Panel III (ATP III). Statistical analysis of the data was done using statistical processing software (SPSS 17).
Results: Metabolic syndrome was significantly more common among patients with psoriasis than among controls [42% vs 22%, odds ratio (OR) = 2.5674, P < 0.0028]. Psoriatic patients also had higher prevalence of triglyceridemia (59% vs 35%, P = 0.0008), hypertension (37% vs 12%, P = 0.0001), and impaired blood glucose levels (56% vs 24%, P = 0.0001) compared to controls. Significant correlation has been found between disease duration and severity, and metabolic syndrome.
Conclusion: Metabolic syndrome is more common in patients with psoriasis than in the general population. As most of the studies from India as well as the rest of the world are proving this association, psoriasis can be considered as one of the markers of metabolic syndrome.

Keywords: Metabolic syndrome, psoriasis, South India


How to cite this article:
Aruna C, Rao G V, Ramanamurthy P, Rambabu P. Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case control study from a tertiary care center in Andhra Pradesh. J NTR Univ Health Sci 2016;5:13-6

How to cite this URL:
Aruna C, Rao G V, Ramanamurthy P, Rambabu P. Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case control study from a tertiary care center in Andhra Pradesh. J NTR Univ Health Sci [serial online] 2016 [cited 2020 Jul 15];5:13-6. Available from: http://www.jdrntruhs.org/text.asp?2016/5/1/13/178948


  Introduction Top


Psoriasis is a chronic inflammatory skin disorder affecting 1-3% of the population. Psoriasis may act as an external indicator of underlying immunological and metabolic dysregulation. [1] Recently, many studies have shown an association between psoriasis and metabolic syndrome, the latter being a conglomerate of obesity, diabetes, hypertension, and atherogenic dyslipidemia. These diseases share a common pathophysiological link permitting them to join atherosclerosis and consequent cardiovascular diseases. Though the association has been documented from all over the world, there is a paucity of reports from India, especially from South India.


  Materials and methods Top


This is a hospital-based case control study conducted over a period of 18 months from September 2009 to January 2011, involving a series of 100 patients who attended the outpatient Department of Dermatology, Venereology, Leprology. Patients with psoriasis aged more than 25 years, with disease duration of at least 6 months who were not on any systemic therapy for the disease 1 month before enrollment were included in the study. Age- and sex-matched patients who attended the Dermatology department for other minor skin ailments were the controls. After obtaining informed consent from all patients, data were collected based on a standard pro forma, which included age, gender, age of onset, and duration of disease, joint pains, smoking and alcohol consumption, type and severity of psoriasis, height and weight, body mass index, etc. Severity of psoriasis was assessed according to Psoriasis Area and Severity Index (PASI) and body surface area (BSA). Waist circumference was determined by placing tape horizontally at the uppermost part of the hip bone around the abdomen, and blood pressure was recorded as the average of two measurements after asking the patients to rest for 5 min. Serum samples were taken after the subjects fasted overnight for at least 8 h. Serum high-density lipoprotein (HDL) cholesterol and triglycerides were measured by means of enzymatic procedures. Plasma glucose was measured using a glucose oxidase method. Metabolic syndrome was diagnosed by the presence of three or more of the five criteria of the National Cholesterol Education Program Adult Panel III (ATP III): Waist circumference >102 cm in men or >88 cm in women; hypertriglyceridemia >1.7 mmol/L (150 mg/dL); HDL cholesterol <1.0 mmol/L (40 mg/dL) in men or <1.3 mmol/dL (50 mg/dL) in women; blood pressure >130/85 mmHg; fasting plasma glucose of >6.1 mmol/L (100 mg/dL). Statistical analysis of the data was done using statistical processing software (SPSS 17, IBM.com). The study was approved by the institutional Ethical Committee.


  Results Top


The study included 100 cases and 100 controls. The descriptive characters are listed in [Figure 1] and [Figure 2]. PASI scores ranged from 0.5 to 30 (mean PASI = 10.22) and BSA from 2% to 90% (mean BSA = 13.5). Disease duration in cases ranged from 6 months to 20 years with a mean disease duration of 5.4 years. We found a higher prevalence of metabolic syndrome among cases (42/100 = 42%) than among controls (22/100 = 22%) with an odds ratio (OR) 2.5674, P < 0.0028. Individual components of metabolic syndrome such as impaired blood glucose level, hypertension, and dyslipidemia are more prevalent among cases than controls. The prevalence of various components of metabolic syndrome among cases and controls are listed in the [Table 1]. In all age groups, higher prevalence of metabolic syndrome was noted among cases than controls with a peak in the age group of 45-55 years with no significant gender difference. Among the cases, metabolic syndrome was common in patients with longer mean disease duration. Prevalence of metabolic syndrome correlated with severity of psoriasis in terms of PASI score as well as BSA. The details are listed in [Table 2].
Figure 1: Males outnumbered females

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Figure 2: Majority of the patients in age group 36-55 years (54%)

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Table 1: The distribution laboratory findings in cases and controls


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Table 2: Descriptive features of psoriatic patients with and without metabolic syndrome


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  Discussion Top


Psoriasis is a prototypical T helper (Th)1 inflammatory disease characterized by the activation and expansion of Th1 cells, Th1 cytokines, and antigen-presenting cells. These mediators have pleiotropic effects on diverse processes such as epidermal proliferation, insulin signaling, angiogenesis, adipogenesis, lipid metabolism, and immune cell trafficking. Therefore, the metabolic effects of chronic Th1 inflammation in psoriasis have the potential to impact conditions such as diabetes, obesity, and atherosclerosis, and in turn the inflammatory molecules and hormones produced in the latter conditions may influence the pathogenesis of psoriasis by promoting susceptibility to the development of psoriasis or through increasing the severity of established psoriasis. [2]

Our study observed a higher prevalence of metabolic syndrome among psoriatic patients than among controls (42% vs 22%, OR 2.5674, P ≤ 0.0028), which is similar to the results of a well-designed, cross-sectional study by Gisondi et al. (30.1% vs 20.6%, OR 1.65, P = 0.005) and one by Nisa and Quazi (28% vs 6%, P < 0.05). On the contrary, a study done by Lakshmi et al. from South India showed no significant correlation (32% vs 30%, P = 0.8094). [3],[4],[5] We found higher prevalence of individual components of metabolic syndrome, except obesity, among the cases; different associations have been reported from various studies done in India such as by Nisa and Qazi, who observed a significantly higher prevalence of dyslipidemia, impaired glucose levels, and hypertension, whereas Khunger et al. found a significant association with all components except diabetes; Pereira et al. reported a significantly higher prevalence of impaired fasting glucose but no association between psoriasis and metabolic syndrome; and Raju et al. from South India found higher prevalence of all components of metabolic syndrome in patients with psoriasis, concluded that psoriasis should not be perceived as merely "skin deep," and recommended screening for cardiovascular comorbidities. [4],[6],[7],[8] This difference could be due to dietary and ethnic differences in different parts of the country. We also observed that metabolic syndrome was common in patients with longer disease duration. Factors such as stress, depression, psychosocial inactivity, and inflammatory mediators in psoriatics possibly favor metabolic syndrome. Microscopy of chronic plaque psoriasis has shown cluster of differentiation (CD)4 T cells and macrophages along with inflammatory cytokines [interleukin (IL)-6, IL-8, IL-17, and tumor necrosis factor-alpha (TNF-α)], the milieu being exactly similar to atherosclerotic plaque. [9] This was reflected in our study and a few others [10],[11] as a significant association between disease severity and metabolic syndrome, in contrast to the study done by Madanagobalane and Anandan, who recommended screening for metabolic syndrome in psoriatics irrespective of disease severity. [12] Ali et al. also found that association with metabolic syndrome is not limited to severe disease and chronicity, and emphasized the need for screening for metabolic syndrome even in young patients with mild disease. [13] However, further studies including larger numbers of subjects are necessary for drawing conclusions. While cardiovascular disease remains a silent killer neglected by many for years, psoriasis, being a visible disease, should prompt early dermatological consultation, considering its impact on social interactions and quality of life. Our study highlights the need for a comprehensive and multidisciplinary investigative approach to the management of psoriasis, as well as a number of other potential serious cardiovascular comorbidities, and the need to consider psoriasis as one of the markers of metabolic syndrome.

Acknowledgment

We wish to thank Siddartha Medical College, beside NTR University, Vijayawada.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kourosh AS, Miner A, Menter A. Psoriasis as the marker of underlying systemic disease. Skin Therapy Lett 2008;13:1-5.   Back to cited text no. 1
    
2.
Azfar RS, Gelfand JM. Psoriasis and metabolic disease: Epidemiology and pathophysiology. Curr Opin Rheumatol 2008;20:416-22.  Back to cited text no. 2
    
3.
Gisondi P, Girolomoni G. Psoriasis and atherothrombotic diseases: Disease-specific and non-disease-specific risk factors. Semin Thromb Hemost 2009;35:313-24.  Back to cited text no. 3
    
4.
Nisa N, Quazi MA. Prevalence of metabolic syndrome in patients with psoriasis. Indian J Dermatol Venereol Leprol 2010;76:662-5.  Back to cited text no. 4
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5.
Lakshmi S, Nath AK, Udayashankar C. Metabolic syndrome in patients with psoriasis: A comparative study. Indian Dermatol Online J 2014;5:132-7.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Khunger N, Gupta D, Ramesh V. Is psoriasis a new cutaneous marker for metabolic syndrome? A study in Indian patients. Indian J Dermatol 2013;58:313-4.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Pereira RR, Amladi ST, Varthakavi PK. A study of the prevalence of diabetes, insulin resistance, lipid abnormalities, and cardiovascular risk factors in patients with chronic plaque psoriasis. Indian J Dermatol 2011;56:520-6.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Raju BP, Nagaraju U. Psoriasis uncovered - comorbid conditions with special reference to metabolic syndrome. Our Dermatol Online 2014;5:14-7.  Back to cited text no. 8
    
9.
Späh F. Inflammation in atherosclerosis and psoriasis: Common pathogenic mechanisms and the potential for an integrated treatment approach. Br J Dermatol 2008;159(Suppl 2):10-7.   Back to cited text no. 9
    
10.
Prathap P, Asokan N, Manjula VD. A case control study to determine the association of psoriasis with metabolic syndrome in a tertiary care centre. IJSRP 2014;4:1-4.  Back to cited text no. 10
    
11.
Karoli R, Fatima J, Shukla V, Dhillon KS, Khanduri S, Maini S, et al. A study of cardio - metabolic risk profile in patients with psoriasis. J Assoc Physicians India 2013;61:798-801.  Back to cited text no. 11
[PUBMED]    
12.
Madanagobalane S, Anandan S. Prevalence of metabolic syndrome in South Indian patients with psoriasis vulgaris and the relation between disease severity and metabolic syndrome: A hospital-based case-control study. Indian J Dermatol 2012;57:353-7.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Ali NM, Kuruvila M, Unnikrishnan B. Psoriasis and metabolic syndrome: A case control study. Indian J Dermatol Venereol Leprol 2014;80:255-7.  Back to cited text no. 13
[PUBMED]  Medknow Journal  


    Figures

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    Tables

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