Introduction
Around the globe, psoriasis impacts approximately 2–3% of individuals, making it a prevalent chronic disorder with introspective challenges. Characteristic symptoms of this condition include scaly or flaky erythema, covering not only the entire skin surface but also the extremities. The complications arising from psoriasis may escalate to serious systemic disorders and impairments, culminating in significant physical discomfort and substantial psychological distress for the sufferers.
Current research links psoriasis to various comorbidities, with metabolic syndrome being the most significant and common. It has been shown that dyslipidemia can serve as a potential risk factor for patients. Although the connection between psoriasis and metabolic syndrome is increasingly acknowledged, the specific interactions with cholesterol remain somewhat unclear. Investigations indicate that individuals with psoriasis often exhibit decreased levels of high-density lipoprotein (HDL) and elevated levels of low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL). Furthermore, there is evidence showing psoriasis can alter the composition of HDL and its cholesterol efflux capacity. Interestingly, several observational studies focused on psoriatic arthritis have revealed no significant correlation between psoriatic arthritis and serum triglycerides (TG), HDL-C, or LDL-C. This has generated considerable debate and uncertainty regarding the relationship between psoriasis and plasma lipids, as it stands vulnerable to biases stemming from publication and environmental factors.
The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) emerges as a vital statistic in assessing lipid status concerning atherosclerosis. A multitude of illnesses is associated with NHHR, including depression, infertility, osteoporosis, and kidney stones. Furthermore, it showcases robust capabilities in identifying insulin resistance and the metabolic syndrome.
This study aims to use NHANES data from the years 2009 to 2014 to further explore the association between NHHR and psoriasis, contributing to the understanding that NHHR is a significant indicator for early risk assessment of psoriasis.
Methods
Study Population
The NHANES database provided a source for our study, which is a comprehensive cross-sectional survey of U.S. population data conducted biannually by the National Center for Health Statistics (NCHS). Access to this database is made available for public use at https://www.cdc.gov/nchs/nhanes/. Our study included data collected from 2009 to 2014, analyzing a total of 30,468 participants. After excluding 10,941 individuals with incomplete psoriasis information and 1,823 subjects with missing NHHR values, along with those under the age of 20, we were left with a final sample of 15,951 participants.
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Figure 1 Flowchart of the sample selection from NHANES 2009–2014.
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Variables for Study
Evaluation of NHHR
Utilizing participants’ cholesterol measurements, NHHR was computed by dividing the Non-HDL-C level by HDL-C level. This involves initially calculating the Non-HDL-C level by subtracting HDL-C from total cholesterol, thus allowing for precise calculation of NHHR, which served as the exposure variable in the study.
Evaluation of Psoriasis
For our research, psoriasis was identified as the dependent variable. Participants were diagnosed with psoriasis if they answered affirmatively to the inquiry: “Have you ever been told by a doctor or other health care professional that you had psoriasis?” This self-reported information was verified through other research demonstrating the reliability of self-reported psoriasis histories.
Assessment of Covariates
Other recognized variables impacting the relationship between NHHR and psoriasis were incorporated into our study. These included continuous variables such as age (20 years and above), income-to-poverty ratio, weight, BMI, triglyceride levels, LDL-cholesterol, total cholesterol, and HDL-cholesterol metrics. Categorical variables included gender, race, education level, history of smoking 100 cigarettes or more, diabetes status, and marital status.
Statistical Analysis
Our analysis adhered to the complex sampling survey design specifications, utilizing adequate NHANES sample weights. Statistical evaluations were executed following the protocols established by the Centers for Disease Control and Prevention (CDC). The baseline characteristics of continuous variables were presented as means ± standard deviation, while categorical data were expressed in percentage terms. To assess the connection between NHHR and psoriasis, logistic regression analysis was employed, yielding odds ratios (OR) along with 95% confidence intervals (CI). Various models were examined, with Model 2 adjusting for age, race, and gender, while Model 1 omitted covariate adjustments. Model 3 further accounted for diabetes status, smoking habits, income-to-poverty ratio, marital status, and educational attainment. Additional sensitivity analyses categorized NHHR into tertiles, and smoothed curve fitting was utilized to elucidate the association trends. Recognizing psoriasis’s diverse impact across different demographics such as gender, race, diabetes history, and smoking habits, an interaction test was conducted to determine the stability of the relationship between NHHR and psoriasis across these groups. Statistical significance was identified with two-tailed P values.
Results
Baseline Attributes of the Participants
This analysis comprised 15,951 participants, with the mean age recorded at 49.07±17.66 years, as sourced from the NHANES data spanning 2009 to 2014. Among these, 51.47% were female while 48.53% were male. Participants were categorized based on the presence or absence of psoriasis.
Table 1 illustrated significant differences between the two groups across parameters such as age, race, weight, BMI, diabetes history, smoking habits, and NHHR, indicating varied health outcomes dependent on psoriasis status.
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Table 1 Comparison of Characteristics of Psoriasis Patients and Non-Psoriasis Participants
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Associations Between Psoriasis and NHHR
The results showcasing the associations between NHHR and psoriasis are encapsulated in Table 2. Initial unadjusted analysis in Model 1 revealed an 8% increased risk of psoriasis associated with each unit increase in NHHR. Similarly, both Model 2 [1.08 (1.02, 1.15)] and Model 3 [1.07 (1.01, 1.14)] upheld this correlation. Following this, sensitivity analyses considered NHHR categorically (tertiles) demonstrated that, in Model 3, the likelihood of experiencing psoriasis was found to be 39% higher in the highest tertile (T3) compared to the lowest tertile (T1). Graphical representation in Figure 2 demonstrated a clear positive association between NHHR and psoriasis through smoothed curve fitting.
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Table 2 The Association Between Psoriasis and NHHR
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Figure 2 Detected Smooth Curve Fitting Indicating a Positive Connection Between NHHR and Psoriasis.
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Subgroup Examination
The stability of the NHHR and psoriasis relationship was further assessed through subgroup analyses, as shown in Table 3. The results indicated consistent effect sizes across demographic subgroups with no notable disparities influenced by smoking, gender, ethnicity, or diabetes history. The positive correlation between psoriasis and NHHR persisted, unaffected by these demographic variables.
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Table 3 Subgroup Analysis for the Association Between NHHR and Psoriasis
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Discussion
As a systemic illness, psoriasis is interconnected with metabolic syndrome and an increased risk of cardiovascular diseases. Numerous studies highlight that individuals affected by psoriasis exhibit a greater incidence of metabolic syndrome compared to their counterparts without the condition. Additionally, altered lipid profiles found in psoriasis patients frequently indicate increased serum concentrations of total cholesterol (TC), LDL-C, and triglycerides. Dyslipidemia stands out as a prevalent risk factor for cardiovascular complications. NHHR’s segregation of Non-HDL and HDL cholesterol adds significant value in the context of coronary heart disease assessment.
The clinical implications from this study’s findings hold substantial value, particularly concerning patient care and preventive strategies. By establishing the connection between NHHR and psoriasis, healthcare providers gain a prospective biomarker for identifying patients at elevated risk. This can lead to implementing timely preventive measures and creating a two-part routine for lipid screening that addresses psoriasis risk through abnormal NHHR levels, followed by thorough assessments of skin health. This proactive approach emphasizes frequent monitoring of both lipid levels and skin conditions to facilitate early detection and intervention of related issues. Furthermore, understanding the connection between lipid metabolism and psoriasis is crucial in mitigating disease onset and recurrence, thus contributing to improved quality of life for patients.
This investigation is notable, representing the first of its kind to analyze the NHHR and psoriasis relationship utilizing the comprehensive NHANES database, which is nationally representative. The study’s robustness benefits from accounting for various potential influencing factors; however, there are limitations. Although psoriasis was diagnosed by medical professionals, dependence on self-reported data can introduce reporting biases and lack clinical validation. Additionally, the limited sample size of psoriasis patients may skew results. Due to the cross-sectional nature of this study, the causative relationship between psoriasis and NHHR could not be definitively established. Other variables, such as patients’ daily medications and lifestyle choices, might overshadow findings despite adjusting for various confounders. Therefore, further research is warranted to enhance the understanding of the NHHR and psoriasis relationship and to develop effective preventative and therapeutic strategies.
Conclusions
The data indicates a 7% increase in the risk per unit rise in NHHR, implying a correlation between heightened NHHR and an elevated likelihood of developing psoriasis. Despite this, longitudinal studies are necessary to affirm the reliability of NHHR as a predictive biomarker, ultimately providing scientific backing for the treatment and prevention of psoriasis.
Abbreviations
BMI, Body mass index; NCHS, National Center for Health Statistics; NHANES, National Health and Nutrition Examination Survey; NHHR, Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio; HDL-C, High-density lipoprotein cholesterol; Non-HDL-C, Non-high-density lipoprotein cholesterol.
Data Sharing Statement
Publicly available datasets were examined for this investigation. The information can be accessed at https://www.cdc.gov/nchs/nhanes/.
Ethics Statement
This study is exempt from ethical review and approval as per the ethical guidelines for life science and medical research involving human subjects.
Acknowledgments
The NHANES database is gratefully acknowledged for providing these valuable data.
Author Contributions
Disclosure
No financial or commercial connections that could lead to conflicts of interest relevant to the study were declared by the authors.
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Welcome to the Wild World of Psoriasis: A Deep Dive
So, ladies and gentlemen, gather ‘round as we scrape the surface—much like the unfortunate souls with psoriasis who might have flaked off their last meal—of an enigmatic condition that affects 2–3% of the globe! Yes, we’re talking about psoriasis—where scaly skin and red patches go to party like they’re at a very exclusive club. But it’s not all fun and games; this chronic disorder doesn’t just mess with your skin, it can affect the mind and body, leading to a hefty dose of psychological distress. Who knew skin could have angst!
The Comorbid Chronicles
Now, we’re diving into the juicy bit: psoriasis and its date with metabolic syndrome. Think of it as a dubious pairing—like peas and donuts. Interestingly, there’s a shred of evidence suggesting that high cholesterol may just be the overzealous ex in this relationship. Research indicates that those with psoriasis may live in a HDL-less world, trading high-density lipoproteins for low-density troublemakers—you’d think they’d know better! And if you think we’re done discussing cholesterol, think again! With LDL and VLDL levels fluttering around like they own the field, there’s no shortage of drama.
What’s Driving This Study?
This research wields NHANES data from 2009 to 2014 like a knight’s sword to slay the dragons of confusion surrounding the non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (or NHHR for short—thank goodness for acronyms!). This little ratio is what we will analyze to uncover any correlations with psoriasis. Think of NHHR as the VIP pass to understanding this condition, acting as a signal flare for early detection. Cue the dramatic music!
Study Methods – A Gathering of the Participants
We’re talking about a whopping 15,951 participants strutting their stuff in the NHANES database, parsing through life’s complexities. Our researchers sifted through this crowd like they were at a buffet, cross-referencing age, income, and even whether participants had smoked enough to fill a chimney. If you said “yes” to having been told by a doctor you’ve got psoriasis—and remember friends, don’t bother using the “sore-eye-asis” code unless you’re on a game show—you were counted! It’s like Tinder, but you got matched with a diagnosis and scientific scrutiny instead of a date.
Crunching the Numbers: Statistical Shenanigans
Using a logistic regression model—sounds a bit like a fancy algorithm to find your soulmate, doesn’t it?—the study assessed the odds ratio of psoriasis related to NHHR levels. Spoiler alert: every single increase in NHHR paralleled an 8% uptick in psoriasis risk. Like getting a bonus in a game of chance, except you really don’t want this particular “bonus.”
The Drama Unfolds: Results
Fasten your seatbelts because we hit a mean age of 49.07 years with our study participants. The results showed that those who flaunted high NHHR levels had a 39% higher likelihood of psoriasis. Talk about getting an unwanted upgrade! Cue “Psycho” music as we delve into subgroup analyses—we found no apparent bias based on gender, ethnicity, or diabetes history. Like a universal language, psoriasis is keen on expanding its audience!
So What? The Implications
Hold onto your seats because this study is more than just numbers and charts; it speaks to practitioners yearning for a reliable biomarker to spot the red flags early. Being proactive might just mean more frequent lipoprotein checks—not the kind of checking in you do at a hotel, mind you! And guess what? A little more focus on skin health can improve the quality of life! Who knew having a bit of flakiness could lead to something so constructive?
Conclusions: A Call to Action
So there you have it! The NHHR might just be the unsung hero in the saga of psoriasis risk. Jumping 7% in risk for every unit of NHHR increase? That’s not just a statistic; it’s a clarion call for more studies to validate this link! Get ready for a potential tidal wave of longitudinal studies to ensure we’ve hit the nail right on the head. After all, no one wants to miss the chance to tune into the psoriasis radio—turning static into the best musical number of your career!
Ds of psoriasis present in participants with varying levels of the non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR). The researchers looked for significant associations between the NHHR and the prevalence of psoriasis, controlling for confounding factors like age, sex, and body mass index (BMI). They might as well have been on a quest to find the Holy Grail of cholesterol ratios!
Findings: The Plot Thickens
With a keen eye and meticulous analysis, the study revealed that higher NHHR values were indeed linked with increased odds of psoriasis. Imagine a scene from a medical drama—our researchers uncovering evidence like detectives piecing together clues! This finding aligns with previous research indicating that dyslipidemia is common among those with psoriasis, potentially suggesting a heightened risk of cardiovascular disease for these individuals. After all, what’s a skin condition without a side of cardiovascular risk, right?
Now, What’s Next?
This study has cracked open the door to further exploration. The results advocate for more comprehensive screening of lipid profiles in psoriasis patients. It’s like suggesting people with psoriasis get VIP access to cardiology consultations! As we wade deeper into the murky waters of psoriasis, understanding lipid profiles could unveil new preventative strategies or therapeutic targets. Talk about a win-win!
Conclusion: The Final Word
psoriasis is not merely a skin problem; it’s a complex condition intertwined with metabolic health, challenging our understanding of how chronic inflammation can impact overall health. As our journey through this wild world of psoriasis continues, we must peel back the layers (pun intended) to comprehensively address the needs of individuals battling this condition. After all, in the grand tapestry of health, every thread counts—so let’s keep those threads vibrant and healthy!