European Journal of Cardiovascular Medicine

Psoriasis is a chronic, immune-mediated inflammatory disease of the skin that is increasingly understood as a systemic disorder rather than an organ-limited dermatosis. Genetic susceptibility and dysregulation of the IL-23—Th17 inflammatory axis are central to disease pathogenesis, producing persistent cutaneous inflammation and a circulating proinflammatory milieu. This persistent systemic inflammation underpins many extracutaneous manifestations and contributes to reduced quality of life and increased morbidity among affected individuals [1].

Epidemiological and clinical studies indicate that a substantial proportion of people with psoriasis develop multisystem comorbidities. Psoriatic arthritis (PsA) affects a clinically meaningful minority and frequently follows cutaneous disease; furthermore, patients with psoriasis show increased prevalence of cardiometabolic conditions such as obesity, dyslipidaemia, hypertension and insulin resistance that cluster as metabolic syndrome. Several recent series and systematic appraisals report high rates of metabolic syndrome and cardiometabolic risk factors in psoriasis cohorts, and these risks tend to be greater in patients with more severe skin disease or concomitant joint involvement [2–4].

Beyond cardiometabolic disease, contemporary evidence documents a broad spectrum of associated conditions — including non-alcoholic fatty liver disease, cerebrovascular and coronary disease, and psychosocial comorbidity — which together increase health care needs and long-term risk. Recognition of these associations underlies recent multidisciplinary recommendations that emphasize early screening for comorbid disease, domain-based assessment of PsA, and collaboration between dermatology and medical specialties to optimize outcomes. Parallel advances in targeted systemic therapies further support integrated care pathways that can address both cutaneous and systemic inflammatory burden [4-6].

Given this evolving evidence base, clinicians require pragmatic, hospital-based data that characterize the prevalence and pattern of systemic involvement among patients presenting with psoriasis in routine dermatology practice. This study aimed to describe the frequency of cardiometabolic, hepatic, rheumatologic and inflammatory abnormalities in an unselected cohort of adults with clinically confirmed psoriasis evaluated jointly by dermatology and internal medicine, and to examine relationships between cutaneous severity (PASI) and systemic markers of disease activity and cardiometabolic risk.

Study Design and Setting: This investigation was conducted as a cross-sectional, hospital-based study jointly undertaken by the Departments of Medicine and Dermatology at a tertiary care teaching institution in India. The aim was to characterize systemic involvement among adults with clinically confirmed psoriasis and to evaluate metabolic, cardiovascular, and inflammatory comorbidities from an integrated Medicine–Dermatology standpoint.

Sample Size Determination: A minimum sample size of 160 participants was estimated. The calculation assumed a prevalence of metabolic syndrome of approximately 30% among individuals with psoriasis, with a 95% confidence level and a margin of error of 7%. To compensate for incomplete data or potential dropouts, the target sample was increased to 180 patients.

Sampling Strategy: Participants were recruited through consecutive sampling from dermatology outpatient clinics, with referrals to internal medicine for systemic evaluation. All eligible individuals presenting during the study period and providing informed consent were included.

Inclusion Criteria:

• Adults aged ≥18 years
• Clinically diagnosed psoriasis (any subtype) confirmed by a dermatologist
• Willingness to undergo systemic evaluation and laboratory testing

Exclusion Criteria:

• Individuals on systemic corticosteroids, biologics, or immunomodulators for conditions other than psoriasis
• Known history of chronic liver or kidney disease unrelated to psoriasis
• Pregnant or lactating females
• Patients with acute infections or inflammatory conditions that could alter systemic biomarkers

Clinical Assessment: A structured proforma was used to record demographic information, lifestyle factors, disease duration, and family history. Cutaneous severity was quantified using the Psoriasis Area and Severity Index (PASI). Nail and joint involvement were assessed separately. Blood pressure, anthropometry, and waist circumference were measured following standard guidelines.

Systemic Evaluation: A comprehensive internal medicine review was conducted to identify multisystem manifestations. Evaluations included:

• Metabolic profile: fasting glucose, HbA1c, lipid panel
• Inflammatory markers: ESR and high-sensitivity C-reactive protein
• Liver and renal function tests: ALT, AST, creatinine, and eGFR
• Cardiovascular risk assessment: resting ECG and calculation of 10-year ASCVD risk
• Rheumatologic screening: assessment of enthesitis, dactylitis, and axial symptoms; referred imaging when necessary

Metabolic syndrome was defined according to international consensus criteria.

Laboratory Methods: Blood samples were collected after overnight fasting. Biochemical analyses were performed using automated analyzers calibrated according to manufacturer specifications. Quality control procedures were implemented daily in the central laboratory. ECGs were interpreted by a senior physician blinded to dermatologic findings.

Outcome Measures: Primary outcomes included the prevalence of systemic comorbidities such as metabolic syndrome, dyslipidemia, impaired glucose regulation, and psoriatic arthritis. Secondary outcomes assessed the association between PASI scores and systemic markers, along with correlations between disease duration and metabolic parameters.

Statistical Analysis: Data were analyzed using standard statistical software. Continuous variables were expressed as mean ± standard deviation or median with interquartile ranges, depending on distribution. Categorical variables were summarized as proportions. Group comparisons were performed using the Student’s t-test for continuous variables and chi-square test for categorical variables. Correlations were assessed using Pearson coefficients. A p-value <0.05 was considered statistically significant

A total of 180 adults with psoriasis were enrolled. The mean age of participants was 42.7 ± 12.4 years, and males constituted 62.2% of the sample. The average duration of illness was 8.6 ± 6.1 years, while the mean PASI score at presentation was 11.8 ± 6.3. Nail changes were documented in 35.6%, and 21.1% reported joint-related symptoms consistent with possible psoriatic arthritis. A family history of psoriasis was present in 15.6% of individuals (Table 1).

Evaluation of metabolic and cardiovascular parameters showed that participants had a mean BMI of 27.3 ± 4.6 kg/m², with a corresponding mean waist circumference of 92.5 ± 10.8 cm. The average systolic and diastolic blood pressure values were 132.6 ± 16.3 mmHg and 84.7 ± 10.4 mmHg, respectively. Abnormal glycemic indices were frequent, with mean fasting glucose of 103.9 ± 22.7 mg/dL and mean HbA1c of 5.9 ± 0.8%. Lipid abnormalities were also common, reflected by triglyceride levels of 162.4 ± 78.2 mg/dL and mean LDL concentration of 118.5 ± 31.4 mg/dL. Metabolic syndrome was identified in 30.0% of the cohort, while 22.8% demonstrated a 10-year ASCVD risk ≥7.5% (Table 2).

Systemic inflammatory markers were elevated in a significant proportion of patients. The mean hs-CRP level was 5.8 ± 3.6 mg/L, and the mean ESR was 22.4 ± 11.3 mm/h. Liver enzyme levels—ALT (34.7 ± 14.2 U/L) and AST (29.6 ± 11.1 U/L)—were mildly increased in some participants, while renal function remained largely preserved, with a mean serum creatinine of 0.89 ± 0.23 mg/dL and eGFR of 94.8 ± 15.7 mL/min/1.73 m² (Table 3).

Assessment of systemic comorbidities revealed that dyslipidemia was present in 53.3%, followed by hypertension in 32.2%. Impaired fasting glucose or diabetes was observed in 26.1%, and 21.1% had features suggestive of non-alcoholic fatty liver disease on combined biochemical and ultrasonographic evaluation. Psoriatic arthritis was confirmed in 15.6%, and 20.0% met criteria for obesity (Table 4).

Correlation analyses demonstrated significant positive associations between psoriasis severity (PASI score) and several systemic parameters. PASI showed moderate correlation with hs-CRP (r = 0.35, p < 0.001), waist circumference (r = 0.31, p < 0.001), and BMI (r = 0.28, p = 0.001). Triglycerides (r = 0.22, p = 0.004) and ESR (r = 0.18, p = 0.017) also exhibited significant but weaker correlations. The relationship between PASI and HbA1c was not statistically significant (p = 0.14) (Table 5).

Table 1. Baseline Demographic and Clinical Characteristics of Study Participants (N = 180)

Table 2. Metabolic and Cardiovascular Parameters of Participants

Table 3. Systemic Laboratory Parameters

Table 4. Frequency of Key Systemic Comorbidities Among Participants

Table 5. Correlation Between Psoriasis Severity and Systemic Parameters

In this hospital-based cross-sectional evaluation of adults with clinically confirmed psoriasis, we observed a substantial burden of systemic comorbidity and a significant correlation between the severity of cutaneous disease (PASI score) and markers of metabolic dysfunction and systemic inflammation. These findings strengthen the conceptualization of psoriasis as a multisystem disorder rather than purely a dermatologic condition.

We found that approximately 30% of participants met criteria for metabolic syndrome, and over half exhibited dyslipidaemia. Hypertension and impaired glycaemic regulation were also common. These results are consistent with large-scale studies indicating that psoriasis is frequently accompanied by metabolic and cardiovascular comorbidities. For example, Almenara-Blasco et al. reported an elevated prevalence of lipid metabolism disorders (35.9%) and hypertension (35.5%) in a psoriasis cohort [7]. Moreover, recent analyses report that patients with psoriasis carry a higher incidence of cardiovascular disease (CVD), myocardial infarction, and heart failure than matched controls [8,9]. Together, our findings in an Indian tertiary-care setting confirm that this comorbidity profile is globally relevant and not restricted to Western populations.

The significant positive correlations between PASI score and variables such as BMI (r = 0.28), waist circumference (r = 0.31), triglycerides (r = 0.22), hs-CRP (r = 0.35) and ESR (r = 0.18) suggest that more severe skin disease often parallels a higher systemic inflammatory and metabolic burden. This is congruent with studies showing that more severe psoriasis is associated with increased cardiovascular risk and systemic inflammation. For instance, Svedbom et al. found that systemic biomarkers (GlycA) partly mediated the relationship between skin disease severity and coronary plaque burden [10,11]. Our data extend these observations by demonstrating the link in a South Asian cohort with detailed metabolic profiling.

The findings underscore the intertwined roles of systemic inflammation, adiposity, dyslipidaemia and cutaneous disease activity. In psoriasis, the chronic skin inflammation may contribute to a systemic inflammatory state that promotes endothelial dysfunction, atherogenesis and metabolic dysregulation. On the other hand, adiposity and metabolic syndrome may amplify psoriatic inflammation via adipokines and insulin resistance, establishing a bidirectional pathophysiologic loop. This concept aligns with recent literature indicating that obesity and metabolic dysfunction may not only result from but also exacerbate psoriatic disease [11,12].

Strengths of our study include the combined dermatology-medicine assessment, detailed metabolic and inflammatory profiling, and use of standardized PASI scoring. However, several limitations warrant acknowledgment. The cross-sectional design precludes causal inference and temporal relationships cannot be established. Selection bias is possible given the hospital-based sample, which may favour more severe cases. Additionally, we did not assess subclinical cardiovascular imaging (e.g., carotid plaque or arterial stiffness) which would deepen insights into vascular risk. Finally, our cohort was drawn from a single tertiary centre in India, so generalizability may be somewhat limited.

Prospective longitudinal studies are needed to clarify the temporal sequence between cutaneous psoriasis severity, metabolic dysfunction, systemic inflammation and cardiovascular events. In addition, intervention studies should address whether reducing psoriatic skin inflammation (via biologics or lifestyle intervention) translates into improvement in metabolic/inflammatory parameters and reduction in cardiovascular outcomes. Biomarker-guided risk stratification (for example, GlycA or novel adipokines) may help identify patients at highest systemic risk [13,14

This study reinforces that psoriasis extends beyond a cutaneous disorder and demonstrates substantial multisystem involvement requiring coordinated care between dermatology and medicine. A considerable proportion of patients exhibited metabolic derangements, cardiovascular risk factors, and inflammatory abnormalities, underscoring the systemic inflammatory burden associated with the disease. The presence of comorbidities emphasizes the need for routine, structured screening to enable early detection and timely intervention. A combined Medicine–Dermatology approach may therefore facilitate comprehensive evaluation, optimize management strategies, and potentially improve long-term outcomes in individuals living with psoriasis

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