Metabolic syndrome more prevalent in patients with psoriasis in Singapore

There is a high prevalence of metabolic syndrome (MetS) in patients with psoriasis in Singapore, which is nearly threefold higher than the general population, results of a cross-sectional study have shown.

“Abdominal obesity seemed to play an integral role in an increased prevalence of MetS, and physicians need to be aware of the rising trend of abdominal obesity in Asia,” the researchers said. “Patients with psoriasis should be screened yearly for MetS, and any modifiable cardiovascular risk factors should be actively controlled.”

A total of 338 patients with psoriasis (70.4 percent men) were included, majority of which were Chinese (67.5 percent), followed by Indian (17.2 percent) and Malay (15.4 percent). MetS prevalence stood at 45.3 percent. [Singapore Med J 2019;doi:10.11622/smedj.2019152]

Patients aged >50 years had higher odds of developing MetS (prevalence, 44 percent; p=0.02). Those of Malay ethnicity were significantly more likely to have the following: hypertriglyceridaemia, elevated fasting plasma glucose and abdominal obesity. Furthermore, no significant association was observed between psoriasis severity and risk of MetS.

“Similar to the findings of the National Health Survey, abdominal obesity was higher among Indian and Malay patients with psoriasis compared to Chinese patients,” the researchers noted. [Singapore Fam Physician 2012;38:8-13]

“Focused therapies can be employed to target abdominal obesity, especially among Malay and Indian patients, such as referral to physiotherapists and sport trainers for tailored exercise programmes, and early referrals to dieticians to improve low levels of low-density lipoprotein cholesterol in Indian patients and elevated fasting plasma glucose levels in Malay patients,” they added.

MetS prevalence in Singapore (45.3 percent) was higher compared to that in the UK (34.2 percent), Japan (25.2 percent), Taiwan (22.5 percent) and Italy (30.1 percent), which could be explained by the varying criteria used for diagnosing MetS among these populations. [Diabetes Care 2004;27:1182-1186; J Dermatol Sci 2010;57:143-144; Arch Dermatol 2008;144:1571-1575; Br J Dermatol 2007;157:68-73]

Several organizations proposed criteria for diagnosing MetS, and these included the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), International Diabetes Foundation, World Health Organization and European Group for the Study of Insulin Resistance. The modified NCEP-ATP III guidelines presented a lower waist circumference cutoff point for Asian men and women. This was the “defining criterion” used in the present study.

This cross-sectional study included patients with psoriasis aged 18–69 years who attended a tertiary dermatology referral centre in Singapore from October 2007 to February 2009. The researchers measured the patients’ fasting glucose, lipids, blood pressure, body mass index, and Psoriasis Area and Severity Index. MetS was diagnosed in the presence of three or more criteria of the modified NCEP-ATP III.

“Early diagnosis of MetS will allow for intensive risk factor modification, including lifestyle interventions, weight loss, treatment of hypertension, diabetes mellitus and hyperlipidaemia, to reduce the risk of cardiovascular disease and mortality in patients with psoriasis,” the researchers said.