Synergistic Effect of Psoriasis and Metabolic Syndrome on Risk of All-Cause and Cardiovascular Mortality in US Adults: A Nationwide Cohort Study

Abstract Background Metabolic syndrome (MetS) is a common comorbidity in psoriasis. However, the associations between MetS, psoriasis, and mortality remain largely unclear. Objectives To investigate the synergistic effect of MetS and psoriasis on total and cardiovascular disease (CVD) mortality in a representative sample of US adults. Methods 14,930 participants from the 2003-2006 & 2009-2014 National Health and Nutrition Examination Survey were included in this prospective, nationwide cohort study. Participants were stratified into the psoriasis-/MetS- (reference) group, psoriasis-/MetS+ group, psoriasis+/MetS- group, and psoriasis+/MetS+ group. Results Overall, 14,930 participants, including 50.71% males and mean age of 43 years, were included in the final analysis. The weighted percentages of participants in the psoriasis-/MetS- group, psoriasis-/MetS+ group, psoriasis+/MetS- group and psoriasis+/MetS+ group were 72.77%, 24.36%, 1.94%, and 0.93%, respectively. A total of 874 deaths (246 CVD-related) occurred during a median follow-up of 110 months. Compared to the reference group, the hazard ratios (95% confidence intervals) in psoriasis-/MetS+, psoriasis+/MetS- and psoriasis+/MetS+ groups were 1.788 (1.486-2.152), 0.858 (0.431-1.707), and 2.050 (1.028-4.092), respectively, for all-cause mortality, and 1.856 (1.350-2.552), 1.229 (0.292-5.181) and 4.571 (1.724-12.119), respectively, for CVD mortality. Subgroup analysis showed that this association was not influenced by participants’ age, sex, physical activity, smoking, estimated glomerular filtration rate, and urinary albumin/creatinine ratio. Similar results were obtained in the sensitivity analysis of the main results. Conclusions Presence of comorbid MetS significantly increases all-cause and CVD mortality in psoriasis patients. Dermatologists can potentially aid in reducing mortality rate in psoriasis patients through targeted screening for MetS.