0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Study |

Psoriasis Independently Associated With Hyperleptinemia Contributing to Metabolic Syndrome FREE

Yi-Ju Chen, MD; Chun-Ying Wu, MD, PhD, MPH; Jui-Lung Shen, MD; Szu-Ying Chu, MD; Chih-Kang Chen, MD; Yun-Ting Chang, MD, PhD; Chuan-Mu Chen, PhD
[+] Author Affiliations

Author Affiliations: Departments of Dermatology (Drs Y.-J. Chen and Shen) and Gastroenterology (Dr Wu), Taichung Veterans General Hospital, Department of Life Sciences, National Chung Hsing University (Drs Y.-J. Chen and C.-M. Chen), and College of Public Health, China Medical University (Dr Wu), Taichung; Departments of Dermatology (Drs Y.-J. Chen and Chang) and Internal Medicine (Dr C.-K. Chen), National Yang Ming University, Department of Dermatology, Taipei Veterans General Hospital (Drs Chu and Chang), and Departments of Dermatology, Cardinal Tien Hospital (Dr C.-K. Chen), Taipei, and National Yang Ming University Hospital, I-Lan (Dr Chang), Taiwan.


Arch Dermatol. 2008;144(12):1571-1575. doi:10.1001/archderm.144.12.1571.
Text Size: A A A
Published online

Objective  To evaluate the role of leptin, a 16-kDa adipocyte-derived hormone, in the development of metabolic dysregulation of psoriasis.

Design  Case-control study.

Setting  Referral centers.

Patients  Seventy-seven patients with psoriasis and 81 age- and sex-matched control subjects were included in the study.

Intervention  Enzyme-linked immunoassay of serum samples from study subjects.

Main Outcome Measures  Serum leptin levels and proportions of comorbidities (including hypertension, diabetes mellitus, metabolic syndrome, hypertriglyceridemia, and reduced high-density lipoprotein cholesterol concentrations) in cases vs controls were compared using χ2 and Mann-Whitney tests. The clinical significance of leptin in psoriasis was analyzed using logistic regression models.

Results  Significantly more obesity (odds ratio [OR], 2.67) and hypertension (2.17) (P =.04 for both) were observed in subjects with psoriasis. High serum leptin levels (≥7397.43 pg/mL) were found in female subjects (OR, 6.05; P < .001) and in subjects with obesity (3.45; P =.01), hypertension (2.19; P =.04), metabolic syndrome (3.58; P =.008), and psoriasis (2.25; P =.02). On multivariate analysis, psoriasis (OR, 4.57; P =.009) was significantly associated with hyperleptinemia independent of female sex (26.36; P < .001), metabolic syndrome (4.37; P =.04), and obesity (2.83; P =.12). Finally, patients with psoriasis who had hyperleptinemia tended to be female (P < .001) and manifested obesity (P =.002) and metabolic syndrome (P =.003).

Conclusions  Hyperleptinemia is associated with psoriasis independent of female sex and other conventional cardiovascular risk factors such as obesity and metabolic syndrome. Hyperleptinemia in psoriasis may contribute to metabolic syndrome.

Figures in this Article

Associations among psoriasis, obesity, hypertension, cardiovascular diseases, diabetes mellitus (DM), and metabolic syndrome have been reported.19 Occlusive vascular events, including ischemic heart disease and cerebral infarction, are significantly more common in patients with psoriasis compared with the general population.1 Multiple cardiovascular risk factors, including DM, smoking, obesity, hypertension, and metabolic syndrome, are significantly associated with psoriasis.27 Psoriasis recently has been proposed as an independent risk factor for myocardial infarction, especially in young subjects with severe psoriasis.

Although the underlying mechanisms may be complex, the “obesity of psoriasis” is thought to be a key link to cardiovascular diseases, including DM, stroke, heart disease, hypertension, and myocardial infarction.8 Recent studies4,5,9,10 have demonstrated that the risk of psoriasis is directly related to body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and that patients with obesity are likely to have severe psoriasis. Psoriasis and obesity share similar mediators of inflammation, mainly tumor necrosis factor (TNF) and interleukin (IL) 6, and the effectors of adipocytic and psoriatic inflammation, mainly adipocytes and macrophages, derive from a common mesothelial origin.1113

Leptin, a 16-kDa adipocyte-derived hormone discovered in 1994 (followed by the discovery of many other adipokines), stimulates endocrine activity in adipose tissue and has an active role in regulating energy homeostasis, metabolism, and immune-inflammatory processes.14 Leptin exerts biologic actions through activation of its cognate receptors, which are encoded by the db gene and belong to the type 1 cytokine receptor superfamily. In addition to being a hypothalamus modulator of food intake, body weight, and fat stores, leptin has a role in acute and chronic inflammation via regulation of cytokine expression that modulates the balance of helper T-cell types 1 and 2.15 Therefore, leptin has been implicated in the pathogenesis of autoimmune inflammatory conditions such as type 1 DM, rheumatoid arthritis, and chronic bowel disease.15 Elevated circulating leptin levels recently were reported to be associated with psoriasis.16

The objective of this study was to evaluate the role of leptin, a 16-kDa adipocyte-derived hormone, in the development of metabolic dysregulation of psoriasis. The clinical implications of serum leptin levels relative to psoriasis are also discussed.

PATIENTS

From January 1, 2006, to May 31, 2007, serum samples from 77 patients with psoriasis were obtained from the dermatology outpatient departments of Taichung Veterans General Hospital and Taipei Veterans General Hospital, Taiwan. Clinical characteristics of the patients (including age, sex, height, body weight, phenotypes of psoriasis, psoriasis severity score at enrollment, and the presence of psoriatic arthritis) were collected, as well as comorbidities such as DM, hypertension, dyslipidemia (including hypercholesterolemia, hypertriglyceridemia, and reduced high-density lipoprotein [HDL] cholesterol concentration), and other cardiovascular diseases such as heart failure, ischemic heart disease, and cerebral ischemia incidents. Control serum samples were obtained from 81 age- and sex-matched subjects without psoriasis who visited the health examination clinics for routine physical checkups. All participant-derived specimens were collected and archived under protocols approved by the institutional review boards of Taichung Veterans General Hospital and Taipei Veterans General Hospital. A full verbal explanation of the study was given to all participants. They consented to participate on a voluntary basis. Missing clinical information from patients with psoriasis and control subjects was recorded as censored data.

CRITERIA OF METABOLIC SYNDROME

We adopted the definition of the National Cholesterol Education Program's Adult Treatment Panel III for Asian subjects17 in which metabolic syndrome is diagnosed as the presence of 3 or more of the following 5 risk factors: (1) fasting serum glucose level of at least 100 mg/dL (to convert glucose level to millimoles per liter, multiply by 0.0555) or previous diagnosis of type 2 DM; (2) blood pressure of at least 130/85 mm Hg or treatment for hypertension; (3) serum triglyceride level of at least 150 mg/dL (to convert triglyceride level to millimoles per liter, multiply by 0.0113); (4) serum HDL cholesterol concentration of less than 40 mg/dL in men and less than 50 mg/dL in women (to convert cholesterol level to millimoles per liter, multiply by 0.0259); and (5) obesity, defined as waist circumference exceeding 90 cm in men and exceeding 80 cm in women. Instead of measuring waist circumference, we classified BMI of at least 28 as obesity in this study, based on the American College of Endocrinology position statement on the insulin resistance syndrome.18

MEASUREMENT OF SERUM LEPTIN LEVELS

Leptin enzyme-linked immunosorbent assay kits were commercially obtained (Quantikine, product code DLP00; R&D Systems Europe, Oxon, England). The assay kit precoats a monoclonal antibody specific for human leptin onto a microplate to bind soluble leptin in the samples. The sensitivity limit of the assay was 7.8 pg/mL. Serum leptin levels were measured in samples prepared in tubes coated with lithium heparin. All serum samples were preserved at −80°C. Serum samples were diluted, and the immunoassays were performed according to the manufacturer's instructions. All assays were duplicated. The intra-assay and interassay variabilities were less than 5%.

STATISTICAL ANALYSIS

The demographic characteristics of cases and controls were compared using χ2 test. The differences in serum leptin levels were compared using nonparametric Mann-Whitney test. The correlations of serum leptin levels with BMI and age were compared using simple linear regression models. Analyses of nonparametric receiver operating characteristic (ROC) curves were performed to calculate the cutoff values according to the most accurate values obtained. To score the disease severity of psoriasis, we adopted the Physician's Global Assessment system, which comprises a scale from 1 to 7, with 1 representing no skin lesions and 7 representing severe psoriasis. Univariate and multivariate logistic regression analyses were performed to evaluate the associations between serum leptin levels and clinical features of patients with psoriasis. Data were analyzed using commercially available statistical software (SPSS for Windows, version 11.0; SPSS Inc, Chicago, Illinois). Analyses of nonparametric ROC curves were also performed using a software program (STATA for Windows, version 8.0; StataCorp LP, College Station, Texas).

DEMOGRAPHIC DIFFERENCES BETWEEN CASES AND CONTROLS

The mean ages at enrollment of cases and controls were 57.39 and 55.63 years, respectively (Table 1). No statistically significant difference was noted in sex or age between the 2 groups. The median BMI values were 25.39 in cases and 23.54 in controls (P =.03). Obesity (BMI, ≥28) was observed more often in cases compared with controls (odds ratio [OR], 2.67; P =.04). Hypertension (OR, 2.17; P =.04) and hyperglycemia or DM (1.45; P =.32) were more prevalent in cases. The incidence of metabolic syndrome among cases was no higher than that among controls (14.1% vs 16.3%; OR, 0.84). Hypertriglyceridemia and reduced HDL cholesterol concentrations were seen in 28.8% (22 subjects) and 17.5% (13 subjects) of 77 controls, respectively. These results are consistent with the findings of a recent Taiwanese population–based study,19 in which the prevalences of increased triglyceride levels and reduced HDL cholesterol concentrations were 27.5% and 23.4%, respectively. In the present study, a lower incidence of reduced HDL cholesterol concentrations (10.3%) was seen in patients with psoriasis, but this did not reach statistical significance (P = .24). However, a significantly lower incidence of hypertriglyceridemia (10.3%) was observed in patients with psoriasis in our study (P = .01) (Table 1).

Table Graphic Jump LocationTable 1. Demographic Characteristics of Cases and Controls
ASSOCIATION BETWEEN SERUM LEPTIN LEVELS AND OCCURRENCE OF PSORIASIS

Serum leptin levels were positively correlated with BMI (β = .47, P < .001) but not with age (P = .8). The median serum leptin level in cases was significantly higher than that in controls (7311.76 pg/mL vs 4804.11 pg/mL, P =.005) (Figure and Table 2). The median serum leptin levels were significantly higher in female vs male subjects (10 368.75 pg/mL vs 4130.84 pg/mL, P < .001) and in subjects with vs without obesity (11 408.21 pg/mL vs 4882.58 pg/mL, P =.001). Elevated serum leptin levels were observed in subjects with hypertension and ischemic heart disease, but these did not reach statistical significance (P = .12 and P = .54, respectively). Significantly higher serum leptin levels were observed in subjects with metabolic syndrome than in those without metabolic syndrome (median, 7814.12 pg/mL vs 4826.58 pg/mL, P = .02).

Place holder to copy figure label and caption
Figure.

Serum leptin levels in the study groups. Values noted are the medians.

Graphic Jump Location
Table Graphic Jump LocationTable 2. Associations Between Serum Leptin Levels and Clinical Characteristics of Study Subjects
INDEPENDENT ASSOCIATION OF PSORIASIS WITH HYPERLEPTINEMIA

To further examine the predictive values of serum leptin levels relative to comorbidities of psoriasis, cutoff values were calculated using ROC curve analyses. Metabolic syndrome could be predicted with an accuracy of 66.89% (65.22% sensitivity and 67.19% specificity) using a serum leptin level cutoff value of 7397.43 pg/mL. Female sex (OR, 6.05; P < .001), obesity (3.45; P =.01), metabolic syndrome (3.58; P =.008), psoriasis (2.25; P =.02), and hypertension (2.19; P =.04) were significantly associated with hyperleptinemia (Table 3). On multivariate logistic regression analysis, psoriasis was an independent risk factor for hyperleptinemia (OR, 4.57; 95% confidence interval [CI], 1.47-14.23; P =.009). Other independent risk factors for hyperleptinemia were female sex (OR, 26.36; 95% CI, 7.41-93.75; P < .001) and metabolic syndrome (4.37; 1.06-17.96; P =.04).

Table Graphic Jump LocationTable 3. Univariate and Multivariate Analyses of Risk Factors for High Serum Leptin Levels
ASSOCIATION OF HYPERLEPTINEMIA WITH MULTIPLE RISK FACTORS FOR METABOLIC SYNDROME IN PATIENTS WITH PSORIASIS

We next analyzed the clinical significance of serum leptin levels among patients with psoriasis. Female sex (13 816.31 pg/mL in women vs 4882.58 pg/mL in men, P < .001) and obesity (14 500.40 pg/mL in obese subjects vs 5143.98 pg/mL in nonobese subjects, P =.002) were associated with significantly higher serum leptin levels (Table 4). Age, severity of psoriasis, presence of psoriatic arthritis, and clinical phenotypes of psoriasis (psoriasis vulgaris vs erythrodermic, pustular, and guttate psoriasis) seemed to have no effect on serum leptin levels in patients with psoriasis. With regard to comorbidities, significantly higher serum leptin levels were seen in patients having psoriasis with metabolic syndrome compared with those without metabolic syndrome (median, 16 059.46 pg/mL vs 5175.92 pg/mL, P =.003). Elevated serum leptin levels were also observed in patients with psoriasis who had DM, hypertension, and dyslipidemia, but these did not reach statistical significance (P = .23, P = .10, and P = .12, respectively).

Table Graphic Jump LocationTable 4. Associations Between Serum Leptin Levels and Clinical Characteristics of Cases

In this study, psoriasis was associated with several adverse cardiovascular factors, including obesity, hypertension, and hyperglycemia, although these did not always reach statistical significance. Our results are consistent with those of previous studies.19 Metabolic syndrome prevalences of 20% to 40% have been reported among epidemiologic studies19,20 in Taiwan. Our lower prevalences of metabolic syndrome (16.3% [13 subjects] in controls vs 14.1% [11 patients] in cases) may have occurred because of missing data on lipid profiles and BMI values in our study.

The direct mechanisms of the association between metabolic disturbances and unfavorable cardiovascular events in psoriasis have yet to be elucidated. In a cross-sectional study,21 subjects with metabolic syndrome had lower serum adiponectin levels and higher serum leptin levels than subjects without metabolic syndrome, and both adipokine levels were found to be related to insulin sensitivity independent of age and BMI. Both adipokines are strongly associated with sex steroids, and this might explain the female-specific adipokine expression.21 High leptin levels have also been reported to be significantly associated with stroke and myocardial infarction independent of traditional cardiovascular risk factors and obesity.22

After adjustment for sex, BMI, and conventional cardiovascular risk factors (including hypertension and metabolic syndrome), psoriasis was independently associated in our study with hyperleptinemia. In addition, hyperleptinemia in psoriasis is associated with higher risk of developing metabolic syndrome. This novel finding links the chronic inflammation status of psoriasis with metabolic disturbances. It seems that high circulating leptin levels in psoriasis derive not only from adipose tissue but also from an inflammation process. Body weight loss has been reported to significantly decrease leptin levels and improve insulin sensitivity23,24 and may reduce the likelihood of developing metabolic syndrome and adverse cardiovascular diseases. Body weight loss could potentially become part of the general treatment of psoriasis, especially in patients with obesity.

However, association may not equal causation. Do the proinflammatory mediators in psoriasis stimulate leptin expression, which eventually leads to metabolic dysregulation? Evidence has shown that different inflammatory stimuli, including IL-1, IL-6, and lipopolysaccharides, regulate leptin messenger RNA expression and circulating leptin levels.25 Furthermore, leptin has been reported to be produced by inflammatory regulatory cells, suggesting that leptin expression could trigger or participate in the inflammatory process through direct paracrine or autocrine action.26 Finally, the effect of leptin on immune cells and keratinocytes within psoriatic lesions—or on circulating immune cells of patients with psoriasis—needs to be examined.

Correspondence: Chuan-Mu, Chen, PhD, Department of Life Sciences, National Chung-Hsing University, No. 250, Kuo-Kang Rd, Taichung 402, Taiwan (chchenl@dragon.nchu.edu.tw) or Yun-Ting Chang, MD, PhD, Department of Dermatology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Rd, Taipei, Taiwan 112 (ytchang@vghtpe.gov.tw).

Accepted for Publication: April 23, 2008.

Author Contributions: Dr Y.-J. Chen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Y.-J. Chen and Wu contributed equally to the article. Study concept and design: Y.-J. Chen, Wu, and Chang. Acquisition of data: Y.-J. Chen, Wu, Shen, Chu, C.-K. Chen, and Chang. Analysis and interpretation of data: Y.-J. Chen, Wu, and Chang. Drafting of the manuscript: Y.-J. Chen. Critical revision of the manuscript for important intellectual content: Y.-J. Chen, Chang, and C.-M. Chen. Statistical analysis: Y.-J. Chen and Wu. Obtained funding: Y.-J. Chen, Wu, and Shen. Administrative, technical, or material support: Y.-J. Chen, Wu, Shen, Chu, C.-K. Chen, Chang, and C.-M. Chen. Study supervision: Chang.

Financial Disclosure: None reported.

Funding/Support: This study was supported in part by research grants TCVGH-956801A and TCVGH-956802B (2006) and TCVGH-966801A (2007) from Taichung Veterans General Hospital.

Additional Contribution: Nai-Hui Chi provided technical assistance.  

McDonald  CJ Cardiovascular disease in psoriasis [letter]. J Invest Dermatol 1989;92 (4) 646- 647
PubMed Link to Article
Poikolainen  KKarvonen  JPukkala  E Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis. Arch Dermatol 1999;135 (12) 1490- 1493
PubMed Link to Article
Gelfand  JMNeimann  ALShin  DBWang  XMargolis  DJTroxel  AB Risk of myocardial infarction in patients with psoriasis. JAMA 2006;296 (14) 1735- 1741
PubMed Link to Article
Neimann  ALShin  DBWang  XMargolis  DJTroxel  ABGelfand  JM Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006;55 (5) 829- 835
PubMed Link to Article
Herron  MDHinckley  MHoffman  MS  et al.  Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005;141 (12) 1527- 1534
PubMed Link to Article
Sommer  DMJenisch  SSuchan  MChristophers  EWeichenthal  M Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res 2006;298 (7) 321- 328
PubMed Link to Article
Cohen  ADGilutz  HHenkin  Y  et al.  Psoriasis and the metabolic syndrome. Acta Derm Venereol 2007;87 (6) 506- 509
PubMed Link to Article
Sterry  WStrober  BEMenter  AInternational Psoriasis Council, Obesity in psoriasis: the metabolic, clinical and therapeutic implications: report of an interdisciplinary conference and review. Br J Dermatol 2007;157 (4) 649- 655
PubMed Link to Article
Henseler  TChristophers  E Disease concomitance in psoriasis. J Am Acad Dermatol 1995;32 (6) 982- 986
PubMed Link to Article
Naldi  LChatenoud  LLinder  D  et al.  Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005;125 (1) 61- 67
PubMed Link to Article
Bonifati  CCarducci  MCordiali  FP  et al.  Correlated increases of tumour necrosis factor-α, interleukin-6 and granulocyte monocyte–colony stimulating factor levels in suction blister fluids and sera of psoriatic patients: relationships with disease severity. Clin Exp Dermatol 1994;19 (5) 383- 387
PubMed Link to Article
Coppack  SW Pro-inflammatory cytokines and adipose tissue. Proc Nutr Soc 2001;60 (3) 349- 356
PubMed Link to Article
Krueger  JG The immunologic basis for the treatment of psoriasis with new biologic agents. J Am Acad Dermatol 2002;46 (1) 1- 23
PubMed Link to Article
Trayhurn  P The biology of obesity. Proc Nutr Soc 2005;64 (1) 31- 38
PubMed Link to Article
Otero  MLago  RGomez  R  et al.  Towards a pro-inflammatory and immunomodulatory emerging role of leptin. Rheumatology (Oxford) 2006;45 (8) 944- 950
PubMed Link to Article
Wang  YChen  JZhao  YGeng  LSong  FChen  HD Psoriasis is associated with increased levels of serum leptin. Br J Dermatol 2008;158 (5) 1134- 1135
PubMed Link to Article
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection. JAMA 2001;285 (19) 2486- 2497
PubMed Link to Article
Einhorn  DReaven  GMCobin  RH  et al.  American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003;9 (3) 237- 252
PubMed
Hwang  LCBai  CHChen  CJChien  KL Gender difference on the development of metabolic syndrome: a population-based study in Taiwan. Eur J Epidemiol 2007;22 (12) 899- 906
PubMed Link to Article
Lin  CCLiu  CSLai  MM  et al.  Metabolic syndrome in a Taiwanese metropolitan adult population. BMC Public Health 2007;7239
Link to Article
Gannagé-Yared  MHKhalife  SSemaan  MFares  FJambart  SHalaby  G Serum adiponectin and leptin levels in relation to the metabolic syndrome, androgenic profile and somatotropic axis in healthy non-diabetic elderly men. Eur J Endocrinol 2006;155 (1) 167- 176
PubMed Link to Article
Sierra-Johnson  JRomero-Corral  ALopez-Jimenez  F  et al.  Relation of increased leptin concentrations to history of myocardial infarction and stroke in the United States population. Am J Cardiol 2007;100 (2) 234- 249
PubMed Link to Article
Ballantyne  GHGumbs  AModlin  IM Changes in insulin resistance following bariatric surgery and the adipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg 2005;15 (5) 692- 699
PubMed Link to Article
Hamminga  EAvan der Lely  AJNeumann  HAThio  HB Chronic inflammation in psoriasis and obesity: implications for therapy. Med Hypotheses 2006;67 (4) 768- 773
PubMed Link to Article
Faggioni  RFeingold  KRGrunfeld  C Leptin regulation of the immune response and the immunodeficiency of malnutrition. FASEB J 2001;15 (14) 2565- 2571
PubMed Link to Article
Sanna  VDi Giacomo  ALa Cava  A  et al.  Leptin surge precedes onset of autoimmune encephalomyelitis and correlates with development of pathogenic T cell responses. J Clin Invest 2003;111 (2) 241- 250
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure.

Serum leptin levels in the study groups. Values noted are the medians.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Demographic Characteristics of Cases and Controls
Table Graphic Jump LocationTable 2. Associations Between Serum Leptin Levels and Clinical Characteristics of Study Subjects
Table Graphic Jump LocationTable 3. Univariate and Multivariate Analyses of Risk Factors for High Serum Leptin Levels
Table Graphic Jump LocationTable 4. Associations Between Serum Leptin Levels and Clinical Characteristics of Cases

References

McDonald  CJ Cardiovascular disease in psoriasis [letter]. J Invest Dermatol 1989;92 (4) 646- 647
PubMed Link to Article
Poikolainen  KKarvonen  JPukkala  E Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis. Arch Dermatol 1999;135 (12) 1490- 1493
PubMed Link to Article
Gelfand  JMNeimann  ALShin  DBWang  XMargolis  DJTroxel  AB Risk of myocardial infarction in patients with psoriasis. JAMA 2006;296 (14) 1735- 1741
PubMed Link to Article
Neimann  ALShin  DBWang  XMargolis  DJTroxel  ABGelfand  JM Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006;55 (5) 829- 835
PubMed Link to Article
Herron  MDHinckley  MHoffman  MS  et al.  Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005;141 (12) 1527- 1534
PubMed Link to Article
Sommer  DMJenisch  SSuchan  MChristophers  EWeichenthal  M Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res 2006;298 (7) 321- 328
PubMed Link to Article
Cohen  ADGilutz  HHenkin  Y  et al.  Psoriasis and the metabolic syndrome. Acta Derm Venereol 2007;87 (6) 506- 509
PubMed Link to Article
Sterry  WStrober  BEMenter  AInternational Psoriasis Council, Obesity in psoriasis: the metabolic, clinical and therapeutic implications: report of an interdisciplinary conference and review. Br J Dermatol 2007;157 (4) 649- 655
PubMed Link to Article
Henseler  TChristophers  E Disease concomitance in psoriasis. J Am Acad Dermatol 1995;32 (6) 982- 986
PubMed Link to Article
Naldi  LChatenoud  LLinder  D  et al.  Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005;125 (1) 61- 67
PubMed Link to Article
Bonifati  CCarducci  MCordiali  FP  et al.  Correlated increases of tumour necrosis factor-α, interleukin-6 and granulocyte monocyte–colony stimulating factor levels in suction blister fluids and sera of psoriatic patients: relationships with disease severity. Clin Exp Dermatol 1994;19 (5) 383- 387
PubMed Link to Article
Coppack  SW Pro-inflammatory cytokines and adipose tissue. Proc Nutr Soc 2001;60 (3) 349- 356
PubMed Link to Article
Krueger  JG The immunologic basis for the treatment of psoriasis with new biologic agents. J Am Acad Dermatol 2002;46 (1) 1- 23
PubMed Link to Article
Trayhurn  P The biology of obesity. Proc Nutr Soc 2005;64 (1) 31- 38
PubMed Link to Article
Otero  MLago  RGomez  R  et al.  Towards a pro-inflammatory and immunomodulatory emerging role of leptin. Rheumatology (Oxford) 2006;45 (8) 944- 950
PubMed Link to Article
Wang  YChen  JZhao  YGeng  LSong  FChen  HD Psoriasis is associated with increased levels of serum leptin. Br J Dermatol 2008;158 (5) 1134- 1135
PubMed Link to Article
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection. JAMA 2001;285 (19) 2486- 2497
PubMed Link to Article
Einhorn  DReaven  GMCobin  RH  et al.  American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003;9 (3) 237- 252
PubMed
Hwang  LCBai  CHChen  CJChien  KL Gender difference on the development of metabolic syndrome: a population-based study in Taiwan. Eur J Epidemiol 2007;22 (12) 899- 906
PubMed Link to Article
Lin  CCLiu  CSLai  MM  et al.  Metabolic syndrome in a Taiwanese metropolitan adult population. BMC Public Health 2007;7239
Link to Article
Gannagé-Yared  MHKhalife  SSemaan  MFares  FJambart  SHalaby  G Serum adiponectin and leptin levels in relation to the metabolic syndrome, androgenic profile and somatotropic axis in healthy non-diabetic elderly men. Eur J Endocrinol 2006;155 (1) 167- 176
PubMed Link to Article
Sierra-Johnson  JRomero-Corral  ALopez-Jimenez  F  et al.  Relation of increased leptin concentrations to history of myocardial infarction and stroke in the United States population. Am J Cardiol 2007;100 (2) 234- 249
PubMed Link to Article
Ballantyne  GHGumbs  AModlin  IM Changes in insulin resistance following bariatric surgery and the adipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin. Obes Surg 2005;15 (5) 692- 699
PubMed Link to Article
Hamminga  EAvan der Lely  AJNeumann  HAThio  HB Chronic inflammation in psoriasis and obesity: implications for therapy. Med Hypotheses 2006;67 (4) 768- 773
PubMed Link to Article
Faggioni  RFeingold  KRGrunfeld  C Leptin regulation of the immune response and the immunodeficiency of malnutrition. FASEB J 2001;15 (14) 2565- 2571
PubMed Link to Article
Sanna  VDi Giacomo  ALa Cava  A  et al.  Leptin surge precedes onset of autoimmune encephalomyelitis and correlates with development of pathogenic T cell responses. J Clin Invest 2003;111 (2) 241- 250
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

2,131 Views
80 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs