Link shown between atopic dermatitis and CV conditions

By Staff Writer
People with severe atopic dermatitis (AD) face a raised risk of cardiovascular (CV) disease, including stroke, myocardial infarction (MI) and dying from CV events, a large UK study has shown.

Evidence for a link between the two conditions has been mixed, but, writing in the BMJ, the researchers said these latest findings showed a clinically relevant association.

They analysed records of more than 387,000 adult patients with AD from UK general practices, classifying the patients’ disease as mild, moderate or severe and matching them with 1.5 million patients of similar age and sex but without AD.

Major CV events were recorded over five years from initial diagnosis, and known risk factors were taken into account.

Results showed those with severe AD had a 40% to 50% higher risk of CV death, unstable angina and MI compared with those without AD. Their risk of heart failure was 70% higher and stroke 20% greater.

Overall, AD had a significant association with CV disease, but the risk was seen predominantly in those with severe or more active AD.

‘Targeting cardiovascular prevention strategies among these patients should be considered,’ the researchers said.

The author of an accompanying editorial said the results supported the idea of targeted screening of CV risk factors and could have ramifications for the use of expensive biologic drugs in treating severe AD.

Dermatologist at The University of Sydney, Associate Professor Saxon Smith, said the study did help clarify whether an association existed between the two, but there was not yet enough evidence to change treatment or screening.

‘This study is exciting because it adds to that body of literature which paints the picture of possible associations,’ Professor Smith told Medicine Today.

‘Is it to this inflammatory soup – this systemic inflammation that floats around the body – or is it something specific to atopic dermatitis, or is it just that there’s a coincidence of relationship?’

He said it was important to recognise that AD, like psoriasis, is a systemic condition in terms of the inflammation that could occur.

‘It’s not just a skin condition alone. I think that’s important to recognise so we make sure we optimise management of these patients,’ Professor Smith said.
BMJ 2018; 361: k1786.
BMJ 2018; 361: k2064.