From Our 2010 Archives
Psoriasis, Heart Disease, and Diabetes: What's the Link?
Metabolic Syndrome, a Risk Factor for Heart Disease and Diabetes, More Likely in People With Psoriasis
By Brenda Goodman
Reviewed by Laura J. Martin, MD
Dec. 20, 2010 -- Having psoriasis appears to double the risk that a person will also have a dangerous clustering of risk factors for heart disease and diabetes known as metabolic syndrome, a new study shows.
Previous research has found patients with psoriasis to be at higher risk for getting diabetes and high blood pressure, but the new study, which is in the Archives of Dermatology, is one of the first to document the broader complement of cardiovascular risks associated with the disease.
Psoriasis Is an All-Over Problem
"It is more than skin deep," says Abrar Qureshi, MD, MPH, co-author of the paper and vice chairman of the department of dermatology at Brigham and Women's Hospital in Boston. "We like to tell patients that psoriasis is a systemic disease. The risk for metabolic syndrome is high."
Psoriasis is an autoimmune disease in which the body overproduces skin cells, causing a thick, scaly, red rash to appear on the palms, soles of the feet, elbows, scalp, or lower back. It is thought to be one manifestation of chronic, body-wide inflammation.
Metabolic syndrome is defined as having at least three of the following risk factors for heart disease and diabetes: high blood pressure, too much belly fat, high fasting blood sugar, low levels of HDL "good" cholesterol, and high levels of bad blood fats called triglycerides. Studies have shown that having metabolic syndrome dramatically increases the risk of heart attacks, strokes, peripheral vascular disease, and type 2 diabetes.
Researchers say it's difficult to know which of the two might be driving the other.
"There's evidence on both sides of the fence," says lead study author Thorvardur Jon Lošve, MD, of Landspitali University Hospital in Reykjavik, Iceland. "There's evidence that obesity drives the development of psoriasis. There's also evidence that inflammation drives some components of insulin resistance. It's a real chicken and egg problem at this point."
Metabolic Syndrome and Psoriasis
The new study used blood test results from nearly 2,500 people who participated in the government-sponsored National Health and Nutrition Examination Survey between 2003 and 2006. None had previously been diagnosed with diabetes.
Among study participants who said that a doctor had diagnosed them with psoriasis, 40% had metabolic syndrome, compared to just 23% of those who did not have psoriasis.
The association was particularly strong in women. Nearly half of women with psoriasis had metabolic syndrome, compared to just one in 5 women without psoriasis. In contrast, psoriasis appeared to raise a man's risk of having metabolic syndrome by only about 4%.
"When you get this constellation of factors together, the risk is higher than the sum of the individual factors," Lošve says. "Visit your primary care physician and bring this up."
Lifestyle Changes Can Help Skin and Heart
The important advice for people with psoriasis or metabolic syndrome is to lose weight, since being overweight is thought to make the skin condition harder to manage and drives heart disease risks up, too.
Getting more exercise and eating a healthy diet can help, too.
If lifestyle changes aren't enough, Qureshi says patients may need to think about controlling their underlying inflammation and cardiovascular risks with medications, "But work on the things you can control, your modifiable risk factors, first."
SOURCES: Lošve, T. Archives of Dermatology, published online Dec. 20, 2010.Abrar Qureshi, MD, MPH, Brigham and Women's Hospital, Boston.Thorvardur Jon Lošve, MD, Landspitali University Hospital, Reykjavik, Iceland.
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