Killing two birds with one stone: screening of coronary artery disease and cardiac autonomic dysfunction in psoriasis.

Dear Editor,

We were grateful to read the interesting article by Sarli et al. [1] investigating the relationship between psoriasis and the heart rate recovery (HRR) index. They found that HRR1-5 was significantly lower in patients with psoriasis compared to healthy controls and that HRR1 was well correlated with the duration of psoriasis (r = 0.541, p < 0.001), the psoriasis area and the severity index score (r = 0.511, p < 0.001).

The treadmill exercise test has been used for many years in cardiology practice. It has various clinical applications including non-invasive evaluation of coronary artery disease, cardiac autonomic dysfunction, chronotropic incompetence and functional status [2]. Psoriasis, a chronic inflammatory skin disease, has been linked to an increased risk of cardiovascular morbidity and mortality [3]. However, there is little data regarding the impact of psoriasis on cardiac autonomic dysfunction in patients without any cardiovascular disease. The HRR index, typically measured as a reduction in the heart rate (heart rate/min) in the first minute following the treadmill exercise test and presenting an altered balance within the autonomic nervous system, has drawn increasing attention as an important prognostic marker of cardiovascular status [4,5]. So, Sarli et al. [1] presented for the first time in the literature that psoriasis was associated with a blunted response to heart rate reduction after the treadmill exercise test. Although the authors excluded patients with a history of ischemic heart disease, the treadmill exercise test may also be an important opportunity to screen those patients with regard to the presence of coronary artery disease. In conclusion, both cardiac autonomic dysfunction and ischemic electrocardiographic changes can be evaluated using the treadmill exercise test in psoriatic patients without previously known cardiovascular disease.