Psoriasis and Metabolic Syndrome

A recent abstract published in The Journal of the European Academy of Dermatology and Venereology, summarized the current knowledge surrounding inflammatory mechanisms shared between psoriasis and metabolic syndrome (MetS).¹ Joining The Dermatologist was Dr Jashin Wu,  the abstract’s lead author, to discuss what psoriasis treatments could potentially reduce cardiovascular risk.

Jashin Wu, MD, FAAD, is a voluntary associate professor in the department of dermatology at the University of Miami Miller School of Medicine in Miami, FL.

What is the underlying pathophysiology and what are the underlying inflammatory mechanisms linking psoriasis and MetS?

There is no definitive causal relationship that has been identified. The combination of genetics, common signaling pathways, and environmental factors may contribute to the MetS abnormalities in patients with psoriasis.

How can biologic treatments for psoriasis impact MetS?

Tumor necrosis factor (TNF) inhibitors may increase the risk of obesity in patients with psoriasis. Speaking more broadly about cardiovascular disease, I have written many papers using different data sets that TNF inhibitors are associated with a reduction in heart attack, stroke, and cardiovascular death. Dr Nehal Mehta, who is a cardiologist at the National Institutes of Health, has shown prospectively that patients on a biologic have a reduction in atherosclerosis. This reduction seems to be best with the IL-17 inhibitors, followed by ustekinumab, and then by TNF inhibitors.

What other psoriasis treatments could potentially reduce cardiovascular risk?

There are 2 medications that can increase cardiovascular risk. Cyclosporine can increase blood pressure. Acitretin may increase triglycerides. However, apremilast may cause a weight loss of 5% to 10% of body weight, which is a good thing for our patients with obesity and psoriasis.

What future research is needed to better understand the association between psoriasis and MetS?

We would need a large prospective clinical trial following patients with different classes of systemic therapies over years to see if there are any changes in cardiovascular endpoints, such as heart attack, stroke, and cardiovascular death.

What other pearls would you like to share regarding psoriasis and MetS?

Weight loss and smoking cessation are very important for patients with psoriasis. Treatments work much better when patients are a healthy weight and when they are not smoking.

Reference
Wu JJ, Kavanaugh A, Lebwohl MG, Gniadecki R, Merola JF. Psoriasis and metabolic syndrome: implications for the management and treatment of psoriasis. J Eur Acad Dermatol Venereol. 2022;36(6):797-806. doi:10.1111/jdv.18044