Abstract
To the Editor: We read with interest the article by Ellis et al1Ellis C.N. Neville S.J. Sayyouh M. et al.Epicardial adipose tissue volume is greater in men with severe psoriasis, implying an increased cardiovascular disease risk: a cross-sectional study.J Am Acad Dermatol. 2022; 86: 535-543Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar and believe that a few matters are worthy of discussion. First, models in this study were adjusted by age, sex, body mass index, hypertension, dyslipidemia, elevated fasting blood glucose, high-sensitivity C-reactive protein, current smoker, family history of premature cardiovascular diseases, and epicardial adipose tissue volume (EAT-V). We suggest adding confounders such as gout, body fat, exercise frequency, alcohol consumption, and fatty liver because these are also considered as cardiovascular risk factors and, thus, their inclusion in the study may result in confounding bias. In addition, individuals exhibiting the common comorbidities found in patients with psoriasis, such as inflammatory bowel disease, should be taken into consideration when designing the exclusion criteria of the study.2Loganathan A. Kamalaraj N. El-Haddad C. Pile K. Systematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis.Int J Rheum Dis. 2021; 24: 1112-1120Crossref PubMed Scopus (7) Google Scholar The study by Ellis et al1Ellis C.N. Neville S.J. Sayyouh M. et al.Epicardial adipose tissue volume is greater in men with severe psoriasis, implying an increased cardiovascular disease risk: a cross-sectional study.J Am Acad Dermatol. 2022; 86: 535-543Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar has shown a statistically insignificant relationship between psoriasis and changes in EAT-V levels in women. However, postmenopausal women have been shown to have an elevated risk of psoriasis3Ceovic R. Mance M. Bukvic Mokos Z. Svetec M. Kostovic K. Stulhofer Buzina D. Psoriasis: female skin changes in various hormonal stages throughout life–puberty, pregnancy, and menopause.BioMed Res Int. 2013; 2013571912Crossref PubMed Scopus (32) Google Scholar and higher levels of EAT-V4El Khoudary S.R. Shields K.J. Janssen I. et al.Cardiovascular fat, menopause, and sex hormones in women: the SWAN cardiovascular fat ancillary study.J Clin Endocrinol Metab. 2015; 100: 3304-3312Crossref PubMed Scopus (52) Google Scholar than those in premenopausal women because of hormonal changes in the body. Therefore, we are concerned because menopause may have affected the accuracy of the data collected as a confounding factor. That being said, because coronary artery disease is a leading cause of death in women and because psoriasis is highly associated with cardiovascular disease,5Chen Z. Xu Y. Chen M. et al.Gout augments the risk of cardiovascular disease in patients with psoriasis: a population-based cohort study.Front Immunol. 2021; 12703119Google Scholar we believe that research on the relationship between psoriasis and EAT-V levels in women is needed. Therefore, we suggest future similar studies to be focused on the relationship between psoriasis and EAT-V levels in postmenopausal women so as to assist in controlling the risk factors of coronary artery disease in women. None disclosed.
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