Psoriasis affects approximately 2–3% of the global population and is associated with systemic inflammation. Recent studies have shown an increased prevalence of metabolic syndrome and cardiovascular disease in psoriasis patients, even in the absence of overt cardiovascular symptoms[1]. This study investigates the relationship between psoriasis, metabolic syndrome, and subclinical cardiovascular disease using non-invasive assessments in patients.

Psoriasis is a common, chronic inflammatory disease that is associated with significant impairment in health-related quality of life even in mild cases, and excess cardiovascular and all-cause mortality in patients with more severe disease[2].

Based on an increasing understanding of its immune pathophysiology, psoriasis is now thought to be a systemic disease with potential health implications beyond the skin[3]. This topic is of critical importance because emerging data suggest that patients with more severe presentations of psoriatic disease have a 50% increased risk of mortality that results in approximately 5 years of life lost. Of special interest, diseases which share a similar immune-pathophysiology with psoriasis have been investigated as co-morbid outcomes. For example, Th-1 and Th-17 immune pathways which drive psoriasis are also prominent disease mediators for atherosclerosis and thrombosis. A variety of studies have suggested that patients with psoriasis have an increased risk of myocardial infarction, stroke, vascular inflammation and atherosclerotic conditions independent of traditional risk factors for cardiovascular disease[4-5].

The relationship between psoriasis, metabolic syndrome, and its individual components was further elucidated in a recent large-scaled, population-based prevalence study. Using objective measures of body surface area involvement of psoriasis and direct measurements of metabolic syndrome components, the study showed that increasing psoriasis severity was associated with higher odds of metabolic syndrome[6-7]. The relationship remained robust to different definitions of metabolic syndrome. Of note, several components of the metabolic syndrome – namely, obesity, hypertriglyceridemia and hyperglycemia – demonstrated dose-response associations with psoriasis severity that are independent of other components. These results suggest that psoriasis severity is a driving factor behind metabolic disorders so frequently seen in this patient population, or alternatively, that metabolic disorders lead to worsening severity of psoriasis[8].

Present study was conducted at PIMS, Udaipur, Rajasthan from January 2025 to June 2025 of 150 consecutive patients diagnosed with chronic plaque psoriasis.

Inclusion criteria: Adults aged 18–65 years, confirmed diagnosis of psoriasis (≥6 months), with no known history of cardiovascular events.

Exclusion criteria: Patients with systemic inflammatory diseases other than psoriasis, or with known cardiovascular disease.

Psoriasis Severity: Psoriasis Area and Severity Index (PASI)

Metabolic Syndrome: Defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria:

• Waist circumference
• Fasting blood glucose
• Triglycerides
• HDL cholesterol
• Blood pressure

Subclinical Cardiovascular Disease:

• Carotid intima-media thickness (CIMT) via B-mode ultrasonography
• High-sensitivity C-reactive protein (hs-CRP)
• Ankle-brachial index (ABI)
• Echocardiography for left ventricular diastolic function

Statistical Analysis

Data were analyzed using SPSS. Correlation between PASI scores, presence of MetS, and subclinical CVD markers was examined using Pearson’s correlation coefficient and logistic regression models.

Table 1: Demographic and Clinical Characteristics of Psoriasis Patients (N = 150)

Table 2: Prevalence of Metabolic Syndrome and Its Components

Table 3: Subclinical Cardiovascular Disease Markers in Psoriasis Patients

The table highlights that a substantial proportion of psoriasis patients exhibit abnormal values in various cardiovascular disease markers, with elevated high-sensitivity CRP being the most prevalent (61%), followed by abnormal carotid intima-media thickness (48%). The data suggest that psoriasis is associated with increased cardiovascular risk, even in the absence of overt clinical cardiovascular disease.

Table 4: Correlation of PASI Score with Metabolic and Cardiovascular Parameters

Our findings confirm a high prevalence of metabolic syndrome among psoriasis patients, supporting the hypothesis that systemic inflammation in psoriasis contributes to cardiometabolic derangements. Subclinical cardiovascular disease markers were significantly elevated in this cohort, indicating an increased risk of future cardiovascular events. The correlation between psoriasis severity and both metabolic and cardiovascular parameters emphasizes the need for comprehensive patient care.

Psoriasis should be approached not just as a dermatological condition, but as a systemic disease with metabolic and cardiovascular implications. Early screening for MetS and subclinical CVD in psoriasis patients—even in the absence of symptoms—is warranted.

Langan et al.[9] noted a similar relationship of severity of psoriasis to the presence of obesity, hypertension and elevated fasting blood sugar. However, they categorized the severity of disease based on the percentage of body surface area involvement which may be a poor marker of the severity of inflammation. Of all the components of metabolic syndrome, inconsistencies across various studies are maximal with respect to dyslipidemia, with some studies indicating an association of dyslipidemia with psoriasis and others noting an association with respect to levels of some components of serum lipids.[10] However, several workers were not able to corroborate these findings.

In keeping with our findings, a study from Israel also observed higher electrocardiographic abnormalities in patients with psoriatic arthritis when compared to controls. Nearly more than a fifth had abnormal echocardiogram findings in comparison to 6.7% of controls (P = 0.07). Similar findings have been reported by Biyik et al[11]. in a study of 216 Turkish patients with psoriasis. These are the only available reports on electrocardiographic and echocardiographic abnormalities in psoriasis patients. In these societies, smoking is known to be nonexistent/very low, whereas our patient series showed a 37% prevalence of smoking[12-14]. Our results indicate that smoking could be an additional contributor for electrocardiographic and echocardiogram abnormalities in chronic plaque psoriasis. However, this needs to be confirmed in other Indian settings with large sample sizes and long follow-up.

Metabolic syndrome and subclinical cardiovascular disease are highly prevalent among psoriasis patients. These findings support the integration of cardiovascular risk screening and metabolic evaluations in routine psoriasis care, especially for those with moderate to severe disease. Early identification and management could significantly reduce long-term cardiovascular morbidity.

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