Correlation between Psoriasis Disease Severity and Risk of Cardiometabolic Co-morbidities among Patients in Malaysia and Effect of Obesity on Treatment: A 13-year Registry review (2007–2019)

Background: Systemic inflammation in psoriasis (PsO) is associated with increased cardiometabolic risk, while obesity may reduce treatment response. This study assessed cardiometabolic risk factors and the impact of obesity on treatment efficacy among Malaysian patients with PsO. Materials and Methods: This multicentre longitudinal observational study analysed data of PsO patients from the Malaysian Psoriasis Registry from 2007 to 2019. Results: Among 5103 patients, those with cardiometabolic comorbidities ( n = 1,856) had significantly higher mean body mass indexes (BMIs) (28.10 vs. 26.11; P < 0.001), later PsO onset (42.79 vs. 30.09 years; P < 0.001) and longer disease duration (12.67 vs. 9.96 years; P < 0.001). These patients were more often male (59.4% vs. 53%; P < 0.001) and more likely to have nail involvement (67.5% vs. 64.2%; P = 0.015). Conversely, patients without comorbidities exhibited higher rates of psoriatic arthritis (PsA) (44.7% vs. 21.9%; P < 0.001), more frequent face/scalp involvement (53.1% vs. 47.1%; P < 0.001) and greater quality of life impairment (Dermatology Life Quality Index > 10: 39.7% vs. 29.6%; P < 0.001). Non-obese patients (BMI < 25) achieved better treatment responses compared to obese patients (−13.2% vs. 0.0%; P < 0.05). Odds of developing new cardiometabolic diseases did not differ significantly between biologic and conventional systemic therapies (odds ratio: 0.90; 95% confidence interval: 0.57–1.42). Conclusion: PsO patients with cardiometabolic comorbidities were associated with a later onset and longer duration of PsO, male predominance, higher BMI, lower prevalence of PsA and reduced face/scalp involvement. Obesity negatively impacted severe PsO treatment efficacy.