Psoriasis Linked to Increased Metabolic Syndrome Risk, Mediated by Disease Activity

Patients with psoriasis are at a significantly increased risk of developing metabolic syndrome (MetS), according to findings from a recent systematic review and meta-analysis.1

In addition to identifying psoriasis as an independent risk factor for MetS, the study also found disease activity regulates MetS risk, suggesting a potential dose–response relationship between inflammatory burden and metabolic disorders.1

According to the National Psoriasis Foundation, 125 million people worldwide — 2 to 3% of the total population — have psoriasis, including more than 8 million people in the US. Common comorbid conditions include psoriatic arthritis, cardiovascular disease, obesity, and diabetes/metabolic disorder. Notably, emerging evidence suggests a robust bidirectional relationship between psoriasis and MetS.2,3

“Early recognition of MetS in psoriasis patients is critical for mitigating long-term health risks and improving clinical outcomes,” Xiaoyan Zhang, of the department of dermatology at the China-Japan Friendship Hospital, and colleagues wrote.1 “Therefore, elucidating the relationship between the two can provide a basis for early clinical intervention and reduce the risk of comorbidities.”

To explore the association between psoriasis and MetS and analyze the impact of disease activity on the risk of MetS occurrence, investigators conducted a systematic review and meta-analysis of relevant literature on psoriasis and MetS obtained from China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases. The search period spanned from the establishment of the database to February 2025.

For inclusion in the analysis, studies were required to meet the following criteria:

• Observational design, including cross-sectional, case–control, or prospective/retrospective studies that are peer-reviewed original articles
• Include a case group comprising psoriasis patients and a control group comprising non-psoriasis individuals
• Clinical or pathological confirmation of psoriasis diagnosis
• Use of the NCEP-ATP III or WHO criteria for diagnosing MetS
• Report the prevalence of MetS
• Have adjusted odds ratios (ORs) with 95% CIs, or primary data allowing OR/CI calculation available

Investigators identified a total of 654 articles through the literature search. Ultimately, 14 articles were included in the meta-analysis, involving 9641 psoriasis patients and 2554 cases of psoriasis combined with MetS.1

Upon analysis, the pooled prevalence of clinically significant metabolic dysregulation among psoriatic cases was 26.49% (95% CI, 25.61-27.39%). Comparative analysis against matched control populations revealed greater odds ratios for MetS development in psoriasis cohorts (OR, 1.27; 95% CI, 1.21–1.33; P <.001).1

In a subgroup analysis of MetS based on Psoriasis Area and Severity Index (PASI) scores, investigators found patients with severe psoriasis, defined as PASI ≥ 10, had a greater risk of developing MetS than the control group (OR, 2.247; 95% CI, 1.267-3.985; P <.001). Further meta-regression confirmed a positive linear trend between PASI increments and MetS incidence.1

“In clinical practice, more attention should be paid to the metabolic health of psoriasis patients, regular monitoring should be carried out, and early intervention measures should be taken to prevent the occurrence of MetS,” investigators concluded.1 “Meanwhile, interdisciplinary collaboration is particularly important, and dermatologists should closely cooperate with departments such as endocrinology and cardiovascular medicine to jointly manage the overall health status of patients.”

References

1. Li Z, Gu Z, Xiang J, Zhang X. The incidence of metabolic syndrome in psoriasis patients and its correlation with disease activity: a systematic review and meta-analysis. Front Med (Lausanne). doi:10.3389/fmed.2025.1593003

2. National Psoriasis Foundation. Psoriasis Statistics. December 21, 2022. Accessed June 16, 2025. https://www.psoriasis.org/psoriasis-statistics/

3. National Psoriasis Foundation. Understanding Psoriasis Comorbidities. Accessed June 16, 2025. https://www.psoriasis.org/understanding-psoriasis-comorbidities/