Psoriasis and metabolic disease: epidemiology and pathophysiology

The scientific literature linking psoriasis to metabolic syndrome, and its components, as well as atherosclerosis and myocardial infarction has rapidly expanded. Increasingly, epidemiological studies are establishing the directionality of these associations and psoriasis' role as an independent risk factor in developing these outcomes.

Psoriasis is associated with metabolic syndrome, and its components, such as obesity, diabetes, and hypertension. Obesity has been shown to be an independent risk factor for the development of psoriasis, and is also associated with more severe psoriasis. Psoriasis is associated with diabetes, coronary artery disease, and an increased risk for myocardial infarction independent of traditional risk factors for these disorders. These phenotypically diverse conditions share similar pathologic changes such as chronic inflammation, angiogenesis, oxidative stress, and selected susceptibility genes and loci.

The broad literature linking psoriasis to metabolic disorders has led to changes in standard of care recommendations for patients with psoriasis. In particular, practitioners are encouraged to screen psoriasis patients, especially when disease is severe, for metabolic disorders and cardiovascular risk factors and institute appropriate prevention strategies. Additional studies investigating the role of psoriasis activity and severity as an independent risk factor for developing metabolic disorders, atherosclerosis, and myocardial infarction and the role of psoriasis treatment in altering the risk of developing these serious morbidities are urgently needed.