Is there a relationship between disease duration and P-wave dispersion in patients with psoriasis? Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=iups20 Upsala Journal of Medical Sciences ISSN: 0300-9734 (Print) 2000-1967 (Online) Journal homepage: https://www.tandfonline.com/loi/iups20 Is there a relationship between disease duration and P-wave dispersion in patients with psoriasis? Bilge Bulbul Sen, Emine Nur RIFAIOGLU, Ozlem Ekiz, Eyup Buyukkaya & Nihat Sen To cite this article: Bilge Bulbul Sen, Emine Nur RIFAIOGLU, Ozlem Ekiz, Eyup Buyukkaya & Nihat Sen (2013) Is there a relationship between disease duration and P-wave dispersion in patients with psoriasis?, Upsala Journal of Medical Sciences, 118:3, 204-205, DOI: 10.3109/03009734.2013.785614 To link to this article: https://doi.org/10.3109/03009734.2013.785614 © Informa Healthcare Published online: 27 Mar 2013. 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BILGE BULBUL SEN1, EMINE NUR RIFAIOGLU1, OZLEM EKIZ1, EYUP BUYUKKAYA2 & NIHAT SEN2 1Department of Dermatology, Mustafa Kemal University School of Medicine, Hatay, Turkey, and 2Department of Cardiology, Mustafa Kemal University School of Medicine, Hatay, Turkey Dear Editor We have read with great enthusiasm the recently published article entitled ‘Electrocardiographic P- wave characteristics in patients with psoriasis vulgaris’ by Bacaksız and co-workers (1). They concluded that Pmax and P-wave dispersion (PWD) were signifi- cantly higher in psoriasis patients than in controls (108.8 ± 21.3 ms versus 93.3 ± 13.0 ms, P < 0.01; 67.4 ± 22.9 ms versus 45.0 ± 19.6 ms, P < 0.01, respectively). Furthermore, Pmin was significantly lower in the psoriasis group (41.3 ± 12.3 ms versus 48.3 ± 14.3 ms, P = 0.04) (1). Recently, Ahlehoff et al. showed that psoriasis is associated with an increased risk of atrial fibrillation (AF) (2). Prolongation of PWD has been demonstrated to be an independent risk factor for the development of AF. Therefore, the subject is important in daily practice, and the study deserves further attention, keeping in mind its suc- cessful design and results. Bacaksız et al. showed (1) that the Psoriasis Area and Severity Index (PASI) score was correlated with Pmax and PWD (P = 0.002 and P = 0.005, respec- tively). In addition, there was a significant positive correlation between hsCRP and PWD (r = 0.229, P = 0.001). It was speculated that although the exact mechanism still remains unclear, chronic inflamma- tion may be responsible for the correlation between PASI score and PWD in these patients. Psoriasis is a chronic inflammatory disease, and the inflammation continues for the duration of the disease. Hence, a significant positive correlation between duration of the disease and PWD would be expected. We believe that an evaluation of the relationship between dura- tion of the disease and PWD will help us to under- stand the increased frequency of AF in patients with psoriasis. In addition, patients with coronary artery disease (CAD) were excluded in the study of Bacaksiz et al (1). Epidemiological studies in patients with severe psoriasis have revealed that there is an increased risk of cardiovascular mortality (3,4), and the cardiovascular disease risk has been found to be particularly high in young patients with a severe form of the disease (5,6). It has been postulated that premature occurrence of atherosclerosis is related to why psoriasis patients have an increased risk for developing cardiovascular dis- ease. As we know, there is an important relationship between psoriasis and subclinical coronary atheroscle- rosis, independent of conventional cardiovascular disease risk factors (7-9). Bacaksız et al. (1) did not specify how CAD was excluded, but there might be some subclinical atherosclerosis in their patients. In a previous study, PWD was found to be more significant in patients with stable CAD than in patients with normal coronary angiograms and to be associated with severity of the disease as well (10). Therefore, it would have been helpful if Bacaksiz and co-workers had clearly identified these factors. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Correspondence: Bilge Bulbul Sen, MD, Department of Dermatology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Serinyol, Hatay 31005, Turkey. Fax: +90 326 245 5305. E-mail: bilgebulbul@yahoo.com (Received 5 February 2013; accepted 10 March 2013) ISSN 0300-9734 print/ISSN 2000-1967 online � 2013 Informa Healthcare DOI: 10.3109/03009734.2013.785614 References 1. Bacaksiz A, Erdogan E, Tasal A, Vatankulu MA, Kul S, Sevgili E, et al. Electrocardiographic P-wave characteristics in patients with psoriasis vulgaris. Ups J Med Sci. 2013;118:35–41. 2. Ahlehoff O, Gislason GH, Jørgensen CH, Lindhardsen J, Charlot M, Olesen JB, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study. Eur Heart J. 2012;33:2054–64. 3. Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J. 2010;31:1000–6. 4. Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortal- ity. Arch Dermatol. 2009;145:700–3. 5. Brauchli YB, Jick SS, Miret M, Meier CR. Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case–control analysis. Br J Dermatol. 2009;160:1048–56. 6. Daudén E, Castañeda S, Suárez C, García-Campayo J, Blasco AJ, Aguilar MD, et al. [Integrated approach to comor- bidity in patients with psoriasis]. Actas Dermosifiliogr. 2012; 103:1–64. 7. Yiu KH, Yeung CK, Zhao CT, Chan JC, Siu CW, Tam S, et al. Prevalence and extent of subclinical atheroscle- rosis in patients with psoriasis. J Intern Med. 2013;273:273–82. 8. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296:1735–41. 9. Gisondi P, Fantin F, Del Giglio M, Valbusa F, Marino F, Zamboni M, et al. Chronic plaque psoriasis is associated with increased arterial stiffness. Dermatology. 2009;218: 110–13. 10. Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol. 2005;38:279–84. Letter to the editor 205