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January 24/31, 2007

Psoriasis and Risk of Myocardial Infarction—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(4):361-363. doi:10.1001/jama.297.4.362-b

In Reply: Dr Alevizos and colleagues suggest that the association of psoriasis and MI that we observed may be due to psoriasis-associated depression. Although this possibility requires further research to fully address, confounding by depression is unlikely to explain our results.

First, the prevalence of severe depression in patients with psoriasis and the magnitude of this potential association have not been well established in large, broadly representative population-based studies. The authors refer to a small, specialty clinic–based study that demonstrated that patients hospitalized for psoriasis were more likely to be depressed, based on Beck Depression Inventory scores (mean score in mild-moderate depression range), compared with healthy controls.1 The correlation between depression scores and psoriasis severity was weak (r = 0.29) and it is unclear if these results would generalize to the broader population of patients with psoriasis we studied. Alevizos et al also refer to 1 large study of patients with psoriasis from Italy that found that patients with psoriasis had an average Center for Epidemiologic Studies-Depression scale score of 26.1, which is a borderline score between mild and major depression.2 This study was limited by a low response rate (48%), lack of a control group, and lack of clarity as to the source population used to identify patients with psoriasis.