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To the Editor: Dr Gelfand and colleagues¹ studied the risk of MI in patients with psoriasis. The authors found that psoriasis is an independent risk factor for MI, especially for young patients with severe disease, and hypothesized that exaggerated immune activity could lead to a higher risk for MI by linking T_H1 diseases to atherosclerosis and coronary artery disease. However, the exact mechanism by which T_H1-mediated diseases predispose patients to vascular disease remains unclear.

The study by Wakkee et al² reviewed the mechanisms by which systemic inflammation results in an adverse effect on the cardiovascular risk profile in patients with psoriasis: oxidative stress, endothelial cell dysfunction, hyperhomocysteinemia, and platelet adhesion, together with well-known risk factors for MI such as hypertension and dyslipidemia. We have observed a higher prevalence of hyperhomocysteinemia in patients with psoriasis compared with healthy patients, and an inverse association between severity of psoriasis and plasma . . . [Full Text of this Article]

Mario Malerba, MD
malerba@master.cci.unibs.it
Department of Internal Medicine
University of Brescia
Brescia, Italy

Paolo Gisondi, MD
Biomedical and Surgical Sciences
University of Verona
Verona, Italy

Alessandro Radaeli, MD
Department of Internal Medicine
University of Brescia

Giampiero Girolomoni, MD
Biomedical and Surgical Sciences
University of Verona

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