To the Editor: The prospective cohort study by Dr Gelfand and colleagues1 found that patients with psoriasis had an increased adjusted relative risk for myocardial infarction (MI). In their conclusion, the authors state that psoriasis may confer an independent risk of MI, which is greater in young patients with severe psoriasis. Analyses were performed using conditional logistic regression, adjusted for age, sex, and other major cardiovascular risk factors (hypertension, diabetes, history of MI, hyperlipidemia, smoking, and body mass index).
Other studies have demonstrated the association of psoriasis with severe psychological morbidity, in particular with depression. Devrimci-Ozguven et al2 demonstrated that patients with psoriasis had significantly higher degrees of depression and more body cathexis problems than did controls. Esposito et al3 reported that psoriasis is associated with profound psychological morbidity (particularly with depression) in a large number of patients. In addition, depression is an independent risk factor for coronary heart disease and an aggravating factor for preexisting cardiovascular disease.4 - 6 Moreover, disease-related psychological stress has been associated with an increased risk for coronary artery disease.7
It therefore seems that several influencing and confounding factors, such as depression, psychological disorders, and disease-related stress, could have biased the findings of Gelfand et al. We believe that adjustment for these factors would result in a more accurate estimation of the actual additional risk of MI in patients with psoriasis.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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