| Background and Objective:Psoriasis is a common chronic, immune mediated disease characterized by epidermal hyperplasia, dilated, prominent blood vessels in the dermis and an inflammatory infiltrate of leucocytes. Psoriasis can be associated with other diseases. Recently, psoriasis has been reported to be associated with metabolic disorders that have a great impact on the patients. Metabolic syndrome is a cluster of risk factors including central obesity, atherogenic dyslipidaemia, hypertension and glucose intolerance. Metabolic syndrome is a strong predictor of cardiovascular diseases, diabetes and stroke, increasing the mortality of cardiovascular events significantly compared with every single component.In western and Asian previous studies, psoriasis has been reported to be associated with the components of metabolic syndrome, including obesity, hyperglycaemia and hyperlipidemia. Part of the studies supported that psoriasis is an independent risk factor of metabolic syndrome. Although the number of reports about the association between psoriasis and metabolic syndrome has been increasing in western countries, such reports are rare in China, especially the large-scale epidemiological investigation and case-control study. Therefore, we investigated the association of psoriasis with cardiovascular risk factors and metabolic syndrome in Chinese patients with psoriasis through this large sample case-control study.The purpose of this study was to compare the prevalence of metabolic syndrome and risk factors for cardiovascular diseases in patients with psoriasis and control groups to analyze the association between psoriasis and metabolic syndrome. Meanwhile, the clinical characteristics of the psoriatic patients with metabolic syndrome were analyzed through the comparison of psoriatic patients with metabolic syndrome and psoriatic patients without metabolic syndrome. All the above-mentioned results were made to provide guidance for screening metabolic diseases of psoriatic patients.Materials and methods:We performed a hospital-based case-control study on 859 cases and 1718 controls. The patients and the controls were 1:2 age-and gender-matched. The cases of this study were 859 adult psoriatic patients who visited the Department of Dermatology at the Peking Union Medical College Hospital between the year of 2005 and 2015. Controls were selected from the Department of Physical Examination Center of Peking Union Medical College Hospital in 2015.All patients and controls were investigated for cardiovascular risk factors, including gender, age, ethnic group, height, weight, blood pressure, fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), et al. The cases were investigated for the disease duration, subtype of psoriasis and age of onset as well. The criteria for diagnosing metabolic syndrome were obtained from the Chinese Diabetes Society in April of 2004. We established a database using Excel and Epidata software and completed the statistics analysis by SPSS software.Results:1. Among the 859 psoriatic patients,123 had metabolic syndrome and 736 had no metabolic syndrome. The prevalence of metabolic syndrome in the psoriatic patients was 14.3%. Of the psoriatic patients, the prevalence of overweight/obesity, hyperglycaemia, arterial hypertension, hypertriglyceridaemia and low high-density lipoprotein cholesterol were 41.2%,14.4%,21.2%,31.5%,29.7%, respectively.2. Among the 1718 controls,171 had metabolic syndrome and 1547 had no metabolic syndrome. The prevalence of metabolic syndrome in the controls was 10.0%. Of the controls, the prevalence of overweight/obesity, hyperglycaemia, arterial hypertension, hypertriglyceridaemia and low high-density lipoprotein cholesterol were 36.0%,10.0%,20.8%,21.8%,7.2%, respectively.3. Psoriatic patients had a higher level of body mass index, fasting plasma glucose, diastolic blood pressure, triglyceride and a lower level of HDL-C compared with the controls (P<0.01), while the systolic blood pressure were similar between these two groups.4. Psoriatic patients had a higher prevalence of overweight/obesity, hyperglycaemia, hypertriglyceridaemia and low high-density lipoprotein cholesterol (P<0.01), whereas, the prevalence of arterial hypertension were similar.5. Metabolic syndrome was significantly more common in psoriatic patients than in controls (14.3% VS.10.0%, Odds Ratio 1.51,95% Confidence Interval 1.18-1.94; p=0.001). And the prevalence of metabolic syndrome in psoriatic patients was higher than controls in every age group.6. Psoriatic patients with metabolic syndrome were older and had an elder age of onset and longer disease duration compared with psoriatic patients without metabolic syndrome, while the gender, ethnic group, subtype of psoriasis and psoriasis area and severity index were similar between these two groups.Conclusion:1. Psoriasis is closely associated with metabolic syndrome. Psoriatic patients have a higher prevalence of metabolic syndrome than normal people.2. Psoriatic patients had a higher prevalence of overweight/obesity, hyperglycaemia, hypertriglyceridaemia and low HDL-C. In contrast, there was no significant difference regarding the prevalence of arterial hypertension between the cases and controls.3. Psoriatic patients with metabolic syndrome were older and had an elder age of onset of psoriasis and longer disease duration compared with the psoriatic patients without metabolic syndrome.4. Recent studies have found some common pathways in the pathogenesis of psoriasis and metabolic syndrome, such as genetic inheritance, environmental factors, inflammatory mechanism and pathophysiological aspects, which may provide some biological explanation for the discovery of association between metabolic syndrome and psoriasis by many epidemiological researches.5. To improve the life quality of the psoriatic patients and the effect of the treatment, appropriate screening for metabolic diseases may play an important role in the management of psoriatic patients, especially the elder patients with long duration of disease and late-onset.6. Comprehensive and individual management is encouraged for the psoriatic patients. Meanwhile, psoriatic patients should be encouraged to correct their modifiable cardiovascular risk factors, such as overweight/obesity, hyperglycaemia and dyslipidemia, to manage the psoriasis and decrease the incidence of long-term cardiovascular events simultaneously. |
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