Is psoriasis a risk factor for cardiometabolic disease in women?

This study followed pregnant women and mothers with psoriasis over an 11 year period to gain insight into the link between the immune-mediated skin disease and cardiometabolic disease. (Ольга Тернавск - stock.adobe.com)

It is well established that psoriasis is associated with cardiometabolic disease, though the reason why remains unclear. It is thought that the systemic inflammation linked to the immune-mediated skin disorder may lead to accelerated atherosclerosis, insulin resistance and, eventually, cardiovascular diseases, such as stroke and heart attack.

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Recently, researchers led by Christoffer Blegvad, M.D., used the Danish National Birth Cohort to explore the association between psoriasis and cardiometabolic disease in pregnant women and mothers. Of the 85,000 mothers from the cohort, 2,435 reported having psoriasis (2.9%). The study authors used statistical analysis to reduce confounders such as age, body mass index (BMI) and smoking. For more information on the study methods, click here.

The women with psoriasis were found to have the following associated the comorbidities:

Subgroup 1: Self-reported cardiometabolic disease:

• Hypercholesterolemia was significantly associated with psoriasis even after adjusting for confounders (adjusted OR 1.31; 1.01–1.70).

• Hypertension was not associated with psoriasis (adjusted OR 0.95; 0.76–1.19).

• Type 2 diabetes mellitus was not associated with psoriasis (BMI <25 and >25 adjusted OR 0.60; 0.15–2.44, 0.94; 0.45–1.94 respectively).

• Metabolic syndrome was not associated with psoriasis (adjusted OR 0.93; 0.55–1.58).

Subgroup 2: Hospital-diagnosed severe psoriasis:

• Hypercholesterolemia showed a strong association with psoriasis (adjusted OR 2.71; 1.41–6.41)

• Hypertension was not associated with severe psoriasis (adjusted OR 1.12; 0.44–2.87)

• Metabolic syndrome did not show an association with severe psoriasis (adjusted OR 4.63; 1.38–15.47).

This study adds to the growing literature linking cardiometabolic disease and psoriasis. In this study, however, dyslipidemia was the only cardiovascular risk factor that remained elevated after adjusting for age, smoking and BMI. Suggesting that other cardiometabolic morbidity is mainly associated with traditional risk factors.

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The take home message of this study is that, in this large retrospective Danish cohort, cardiometabolic disease was common in patients with psoriasis. When adjusting for BMI, smoking and age, hypercholesterolemia was associated with psoriasis. However, more patients in the psoriasis cohort were also smokers and had elevated BMIs increasing the risk of cardiometabolic disease.

In practice, patients of all ages who suffer from psoriasis should have traditional cardiometabolic risk factors addressed. This includes diet, exercise and smoking cessation. Furthermore, psoriasis patients should be evaluated for hypertension, diabetes and dyslipidemia and treated accordingly.

References:

Blegvad C, Nybo andersen AM, Adam A, et al. Psoriasis as a Predictor of Cardiometabolic Comorbidity in Women: A Study Based on the Danish National Birth Cohort. Acta Derm Venereol. 2019;99(3):274-278.