The Scientific World Journal
Volume 2012, Article ID 312463, 5 pages
Prevalenceof Metabolic SyndromeinPatients withPsoriasis
Emek Kocaturk,Burce Can,SibelSudogan,andMelek Koc ¸
Department of Dermatology, Goztepe Training and Research Hospital, Istanbul, Turkey
Correspondence should be addressed to Ilkin Zindancı, firstname.lastname@example.org
Received 22 November 2011; Accepted 21 December 2011
Academic Editors: A. Cuocolo and L. Kuller
Copyright © 2012 Ilkin Zindancı et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Psoriasis is a chronic inflammatory skin disorder in which proinflammatory cytokines including IL-6 and TNF-α
increasebothlocally andsystematically. Itisthoughtthatchronicinflammationresultsinmetabolicdiseasesandproinflammatory
cytokines give rise to the development of atherogenesis, peripheral insulin resistance, hypertension, and type 2 diabetes. Our aim
arterial blood pressure were collected. Fasting blood glucose, triglyceride, and HDL levels were determined. International Diabetes
Federation Criteria for Metabolic Syndrome and Insulin Resistance were used for evaluating patients with metabolic syndrome
and diabetes. Results. Compared to the control group, metabolic syndrome, diabetes mellitus, and hypertension were found to be
higher in psoriasis patients. Metabolic syndrome was increased by 3-folds in psoriasis patients and was more prevalent in women
than in men. It was determined that the prevalence of metabolic syndrome was higher in psoriasis patients after the age of 40.
Metabolic syndrome was not related to smoking, severity of psoriasis, and duration of disease. Conclusions. Our findings suggest
that psoriasis preconditions occurrence of a group of diseases such as diabetes mellitus, hypertension, and metabolic syndrome.
For this reason, patients with psoriasis should be treated early and they should be followed with respect to metabolic diseases.
Psoriasis is a chronic inflammatory skin disorder which is
characterized by local and systemic escalation of proinflam-
matory cytokines such as IL-6 and TNF-α [1, 2]. Proinflam-
matory cytokines which take place in chronic inflammation
are accused of augmentation of atherogenesis and peripheric
insulin resistance and thus leading to hypertension and type
association between psoriasis and metabolic disorders such
as obesity, dyslipidemia, and type II DM and it is shown
that severe psoriasis might be associated with increased
mortality rate due to cardiovascular disorders [2, 4–6]. Since
psoriasis is characterized by a systemic inflammation which
involves numerous cytokines and inflammatory markers
in particular TNF-α, it may predispose the patients to
metabolic disorders. We aimed to investigate the prevalence
of metabolic syndrome in patients with psoriasis vulgaris.
The study included 115 psoriasis vulgaris patients and 140
healthy, sex, and age-matched control subjects who do not
have psoriasis and any systemic disease. Inclusion criteria
for cases were age more than 18 years, clinical diagnosis
of chronic plaque psoriasis (lasting at least 6 months), and
not receiving any systemic or local antipsoriatic treatment
for the last 4 weeks. Informed consent was given by all
the patients who enrolled in the study. Information sheets
for the patients included age, gender, weight, height, body
mass index (BMI), waist circumference, smoking habits,
blood pressure, age of onset, and duration of the disease.
Exclusion criteria were pregnancy and psoriatic arthritis.
Severity of psoriasis was assessed by psoriasis area severity
index (PASI) and accepted as severe in patients with PASI
> 10 and mild/moderate in patients with PASI ≤ 10 .
BMI was calculated as weight/height (kg/m2) and metabolic
2The Scientific World Journal
syndrome was diagnosed in the presence of central obesity
in addition to two or more criteria of the International
Diabetes Foundation: waist circumference ≥94cm in men or
≥80cm in women; hypertriglyceridemia ≥150mg/dL; HDL
<40mg/dL in men or <50mg/dL in women; blood pressure
≥130/85mmHg; fasting blood glucose ≥100mg/dL .
Triglyceride and HDL levels were calculated by enzymatic
assay, glucose was calculated by glucose oxidase assay. Stu-
chi-square tests were used for statistical analysis of the data.
Enter logistical regression analysis was used for multivariate
determination of parameters affecting metabolic syndrome.
P values <0.05 were accepted as statistically significant and
confidence interval (CI) was 95%.
The study group included 64 (55.7%) females and 51
(44.3%) males with a mean age of 45.4 (range 19–79) years.
The control group consisted of 70 (50%) females and 70
(50%) males with a mean age of 43.4 (range 19–70) years.
Duration of the disease was 11.4 ± 9.2 years, and mean
age of onset were 34.24 ± 17.3 years. Severity of psoriasis
was mild to moderate in 76 (66.1%) of the patients and
severe in 39 (33.9%) of the patients with a mean PASI of
9.98 ± 8.6. There was a significant difference between the
smoking rates of the groups which were 35.7% and 24.3%
in psoriasis and control groups, respectively (P < 0.05).
Waist circumference ≥94cm in men and ≥80cm in women
was observed in 73% and 83.6% of psoriasis and control
subjects, respectively; waist circumference was significantly
slimmer in psoriasis patients (P < 0.05). Mean BMI was
28.73 ± 6.12kg/m2and 28.22 ± 4,9kg/m2in psoriasis and
control groups, respectively. No significant differences were
found between groups with respect to BMI (P > 0.05).
There were also no significant differences between groups
with respect to high triglyceride levels and low HDL levels
(P > 0.05). In contrast, we found a significant correlation
between psoriasis and hypertension, diabetes mellitus and
metabolic syndrome. Hypertension and diabetes mellitus
were significantly more common in psoriasis patients as
compared to controls. We found a higher prevalence of MS
in psoriasis patients than in controls (53% versus 39%) (P <
0.01). The prevalence of various components of MS in cases
and controls along with P values is given in Table 1.
Although all patients with MS had waist circumference
≥80cm in females and ≥94cm in males, there was no
significant difference with respect to mean BMI between
psoriasis patients and control cases with MS (P > 0.05). But
we observed that female psoriasis patients with MS had a
higher BMI (30.60 ± 7.18 in females versus 26.37 ± 3.37 in
males) (P < 0.01).
Considering the data for diabetes mellitus, hypertension,
and MS in psoriasis patients, it appeared that deviations
from normal were most prevalent at the fifth decade of life
(Table 2). No apparent differences were noted regarding the
prevalence of DM and hypertension between the genders
(P > 0.05). In contrast, we found a significant correlation
between MS and female gender. MS was more common in
female patients than male patients (P < 0.05). The mean age
than patients without MS (P < 0.01). Prevalence of MS was
not correlated to smoking, severity of psoriasis, and duration
of disease (P > 0.05) (Table 3).
Multiple logistic regression analysis revealed that MS is
increased by 2.94-fold in psoriasis patients (95% CI:1.40–
6.19). When the parameters that might influence MS in
ing were evaluated, the model was found highly significant
(P < 0.001) with a Negelkerke (R2) value of 0.293 and
determination coefficient of 72.2%. The influence of female
gender and age on the occurrence of MS in psoriasis patients
was found significant (P < 0.01). Female gender increased
the risk of MS by 3.195-fold (95% CI:1.12–9.04) compared
to males; patients aged between 40–49 had an increased risk
60 had an increased risk of MS by 6.531-fold (95% CI:1.55–
3.37). It was found that MS was independent from smoking
habit (Table 4).
This study reveals that hypertension, diabetes mellitus, and
MS are significantly more common in psoriasis patients than
or individual components of MS might be associated with
psoriasis during the course of this disease. Recent studies
showed that psoriasis is associated with metabolic disorders
such as hypertension, type II DM, dyslipidemia, abdominal
obesity, insulin resistance, and cardiac disorders and the
risk of metabolic syndrome is increased in patients with
psoriasis [2–6, 9–12]. Sommer et al. reported that there is
a significant association between psoriasis and type II DM,
hypertension, hyperlipidemia, and coronary artery disease
and MS is increased by twofolds in a study they conducted
in 581 patients . Other studies showed an increased
frequency of ischemic heart disease, DM, hypertension, and
dyslipidemia in patients with psoriasis when compared to
controls [13, 14]. Gisondi et al. found increased preva-
lence of hypertrygliceridemia and MS in psoriasis patients
compared to controls, but they did not find any difference
between psoriasis patients and controls with respect to low
levels of HDL, DM, and hypertension . Farshchian et
al. failed to demonstrate any difference between psoriasis
patients and controls with regard to fasting blood glucose,
triglyceride, cholesterol, HDL, LDL, and VLDL levels .
In our study we observed that psoriasis is associated with
smoking, DM, hypertension, and MS. DM and hypertension
was accompanying our psoriasis patients along with MS.
These findings confirmed the literature [3, 11, 13, 14]. It
is reported that smoking is more prevalent in psoriasis
patients [13–15]. We found the rates of smoking higher than
controls. Levels of triglyceride and cholesterol were reported
to be high in psoriasis patients [3, 13, 14]. We did not
detect any dyslipidemia in our patients. This was consistent
with previous findings which found normal lipid levels in
The Scientific World Journal3
Table 1: Metabolic syndrome criteria in psoriasis patients and controls.
Psoriasis (n = 115)
Control (n = 140)
Waist circumference (cm)
M ≥ 94; F ≥ 80
M < 94; F < 80
84 (73.0%) 117 (83.6%)
BMI (kg/m2) 0.473
63 (54.8%)85 (60.7%)
F ≤ 50; M ≤ 40
F > 50; M > 50
50 (43.5%)46 (32.9%)
65 (56.5%) 94 (67.1%)
47 (40.9%) 33 (23.6%)
68 (59.1%)107 (76.4%)
56 (48.7%)49 (35.0%)
59 (51.3%) 91 (65.0%)
(+)61 (53.0%) 59 (39.0%)
(−) 54 (47.0%) 91 (65.0%)
++Chi-square test,∗P < 0.05,∗∗P < 0.01.
BMI: Body Mass Index; MS: Metabolic syndrome; F: Female; M: Male; BP: Blood pressure; FBG: Fasting blood glucose.
Table 2: Association of MS, DM, and HT with age in psoriasis patients.
(+)59 18–7951.28 14.43
56 23–7952.62 14.13
47 27–79 54.7613.07
+Student’s t-test,∗∗P < 0.01.
psoriasis patients and concluded that hyperlipidemia did not
have a clinical significance in psoriasis patients [15, 16]. It
has been reported that hypertension and DM were common
in psoriasis patients regardless of gender and hypertension
be seen in any age [3, 13, 14]. In our study, we found both
hypertension and DM in advanced age, regardless of gender.
Although obesity is reported more frequent among
psoriasis patients, we have not found BMI and waist
14]. However we observed a higher prevalence of MS among
psoriasis patients than controls. This may be explained by
the literature which concluded that the association between
psoriasis and MS is independent from the tendency of
psoriatic patients to be obese .
In our study we observed that MS was increased by
3-fold in psoriasis patients. The association of psoriasis
with MS was independent from smoking. These findings
confirmed those in the literature [11, 13, 14, 17]. We found
the prevalence of MS increased by 5-fold in patients aged
between 40 and 59 years. This was consistent with previous
studies by Sommer et al. and Gisondi et al. who reported
that MS was significantly higher in psoriasis patients after
the age of 40 [3, 15]. Cohen et al. also demonstrated that
the association between psoriasis and MS was pronounced
after the age of 50 . However Nisa and Qazi observed the
In contrast to the reports that MS was regardless of
gender, we observed a significant relationship between MS
4The Scientific World Journal
Table 3: The associations of MS with patient characteristics in psoriasis patients.
M ±SD (Median)
39.73 ± 17.03
M ±SD (Median)
+Duration of disease
+Age of onset
+Student’s t-test,++Chi-square test,∗P < 0.05,∗∗P < 0.01.
Table 4: Multiple regression analysis.
95,0% C.I. for Exp (B)
9.04 Gender: F
Age of onset ≥ 40
and gender [3, 11, 15, 17]. MS was more prevalent in women
and female gender increased the prevalence of MS by 3-fold.
High BMI levels were frequent in our female patients
with MS and this finding was confirming the previous
findings . We believe that high frequency of MS in female
patients is the result of increased waist circumference due to
It was reported that MS is related to the duration of the
duration of the disease is longer in patients with MS [3, 15].
But we observed that psoriasis started at advanced age in our
patients with MS and MS was not related to the duration of
association of MS with severity of the disease. Sommer et al.
reported a positive relation with severity, while Gisondi et al.
and Nisa and Qazi declared an independent relation [3, 15,
an association between severity of the disease and MS.
Our results showed that psoriasis predisposes to the de-
velopment of DM, hypertension, and MS and psoriasis in-
creased the prevalence of MS by 3-fold. Therefore, we
recommend evaluating psoriasis patients for the presence
of metabolic diseases which may interfere with the patients’
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