Abstract
Small-scale studies offer conflicting evidence regarding the relationship/association between psoriasis and insulin resistance by HOMA-IR (homeostasis model assessment of insulin resistance). The purpose of this study was to assess the association between baseline HOMA-IR and psoriasis incidence in a large-scale longitudinal cohort of postmenopausal women. The analysis included 21,789 postmenopausal women from the Women’s Health Initiative. Psoriasis diagnosis was defined by fee-for-service Medicare ICD-9-CM codes assigned by dermatologists or rheumatologists, and a 2-year lookback period to exclude prevalent cases. Baseline HOMA-IR was calculated using the updated HOMA2 model. Hazard rates from the Cox regression models were stratified by age (10-year intervals), on WHI component (Clinical Trial or Observational Study), and on randomization status within each of the WHI clinical trials. The complete model also adjusted for ethnicity, waist–hip-ratio, and smoking and alcohol habits. Among participants free of psoriasis at entry, those with high baseline HOMA-IR (≥ 2) compared to low (< 1.4) had significantly higher risk for psoriasis over 21-year cumulative follow-up (HR: 1.39, 95% CI 1.08–1.79, P-trend: 0.011). In postmenopausal women, higher baseline HOMA-IR levels were significantly associated with higher incidence of psoriasis over 21-year cumulative follow-up. Results from this time-to-event analysis indicate that insulin resistance can precede and is associated with an increased risk of psoriasis. Study is limited by Medicare diagnostic code accuracy and cohort age. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00403-021-02298-9.
Highlights
Psoriasis is a chronic inflammatory skin disease that affects about 2–4% of the U.S population
We propose to better characterize the relationship between psoriasis and insulin resistance in a large cohort of postmenopausal women
Our findings suggest that insulin resistance might be explored as an additional therapeutic target in psoriasis patients, especially in those with concomitant diabetes
Summary
Psoriasis is a chronic inflammatory skin disease that affects about 2–4% of the U.S population. Psoriasis can occur at any age, but peaks between age 20 and 30 years and between 50 and 60 years [1]. The fall in estrogen concentration has been attributed to exacerbation of psoriasis [2]. Psoriasis has been traditionally regarded as a disease limited to the skin, it is well known that it has important health implications beyond the skin [4]. Psoriasis is associated with significant comorbidities including type 2 diabetes [5]. The current evidence hints at a complex relationship between psoriasis and insulin resistance. Small case–control studies (n < 200 participants) have attempted to characterize the relationship between psoriasis and insulin resistance using the homeostasis model assessment of insulin resistance (HOMA-IR),
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