CVD risk may rise with atopic dermatitis severity

Complex relationships between immunologic pathways and immune-mediated inflammation may be a contributor, researchers say.

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Patients with atopic dermatitis may be at greater risk of cardiovascular events – and the risk increases with severity of disease, a new study has found.

The authors said the study provided valuable information for clinicians and added to what was already known about the burden of atopic dermatitis, particularly for patients with moderate to severe disease.

“Typically recognised as a childhood disease, there is growing evidence of a high prevalence (up to 23%) and disease burden of atopic dermatitis in adults worldwide,” they wrote.

Despite available management strategies, including topical or systemic therapies, a significant proportion of patients continued to have inadequately controlled disease and persistent risk for multiple comorbidities, the authors wrote.

“Although the risk of cardiovascular outcomes has been evaluated in the atopic dermatitis patient population, data on incidence rates of cardiovascular events among patients with moderate-to-severe atopic dermatitis are limited.”

The retrospective study, published in PLOS One, evaluated incidence rates of cardiovascular events in patients aged 12 years and over with moderate-to-severe disease, in a cohort of Californian healthcare system members without recognised risk factors for adverse events.

Patients with moderate-to-severe atopic dermatitis, as defined by dermatologist-rendered code and prescription history between 2007 and 2018, were included in the study.

Major adverse cardiovascular events such as angina, myocardial infarction, coronary revascularisation, heart failure, cardiac arrhythmias and stroke, as well as venous thrombotic events, deep vein thrombosis and pulmonary embolisms were identified via international classification of diseases codes.

Among the 8197 patients with moderate to severe atopic dermatitis, incidence rates per 1000 person-years for major adverse cardiovascular events were 2.6, followed by venous thrombotic events (2.0), deep vein thrombosis (1.6) and pulmonary embolism (0.7). 

Incidence rates for all events were higher for older patients, patients with diabetes, former smokers, and men, except for pulmonary embolisms, which were higher in women. 

This study did not assess data from patients with mild atopic dermatitis or include a healthy (non-atopic dermatitis) population for comparison, however previous epidemiologic studies have suggested an association between atopic dermatitis and cardiovascular events, the authors wrote.

A recent meta-analysis found an increased relative risk of myocardial infarction, stroke, angina, and heart failure with increasing atopic dermatitis severity in cohort studies, while another study found that inflammatory skin disease such as atopic dermatitis was associated with significantly higher odds of multiple cardiovascular disease risk factors, including hypertension and diabetes, compared to those without an inflammatory skin disease.

“Biologically, atopic dermatitis may contribute to an increased risk of cardiovascular events due to the complex relationship between the immunologic pathways and immune-mediated inflammation in atopic dermatitis,” the authors wrote.

“Studies have shown a strong association between systemic inflammatory diseases and cardiovascular disease; increased cardiovascular risk may be attributable to chronic inflammation, and patients with atopic dermatitis may have increased systemic immune activation as a key basis of comorbidity.

“Furthermore, systemic treatments for atopic dermatitis may affect cardiovascular risk. Previous work demonstrated that risk for cardiovascular events was greatest in patients receiving systemic treatment, although the authors did not distinguish between mild and moderate cases.”

PLOS One 2022, online 17 November