Arterial Stiffness Parameters Should be Evaluated With Different Types of Psoriasis

Abstract

We read with interest the letter of Sen and coworkers regarding our article entitled ‘‘Aortic Arterial Stiffness is a Moderate Predictor of Cardiovascular Disease in Patients With Psoriasis Vulgaris.’’ Sen et al stated that in daily practice, a significant number of patients with psoriasis receive various topical or systemic treatments. Therefore, our study does not exactly represent the real-world situation. Medication and chronic diseases may influence arterial stiffness parameters. This is why we excluded these factors and focussed on 1 type of psoriasis. In other words, we tried to study a more homogeneous population so as to produce credible results. Arterial stiffness can be affected by vascular risk factors (eg, smoking, alcohol consumption, hypercholesterolemia, and hypothyroidism) and medications (eg, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, b-blockers, and statins). We excluded these factors in our study. Regarding conditions that could influence arterial stiffness, we ensured that the patient and control groups are as similar as possible. Multicenter trials with very large number of patients are needed so as to allow matching between study groups and effective multivariate analysis. Such studies are not easily set up or funded. Moreover, findings like ours may help plan what is needed to be measured in such ‘‘larger’’ studies. Psoriasis is associated with an increased risk of cardiovascular disease. For example, a reduced number of endothelial progenitor cells and abnormal endocan levels in patients with psoriasis suggest endothelial dysfunction and increased cardiovascular risk. Arterial stiffness has received attention due to its role as an independent prognostic factor for hypertension, chronic kidney disease, diabetes, and systemic inflammatory diseases such as psoriasis. Clearly, there is a need to investigate the links between arterial stiffness and vascular risk in several conditions. We agree that our study does not exactly represent the realworld situation but you must start somewhere!