Severe, Active Atopic Eczema Linked to Increased Cardiovascular Risk

Severe, predominantly active atopic eczema is associated with an increased risk for cardiovascular disease in adults, according to the results of a population-based matched cohort study published in BMJ.

The investigators sought to explore whether adults with atopic eczema are at a higher risk for cardiovascular disease and whether the risk varies according to the severity of the disease and the activity of the condition over time.

Adults with a diagnosis of atopic eczema were matched with respect to age, sex, general practice, and calendar time with up to 5 control individuals without the condition. The main outcome measures were cardiovascular outcomes, including myocardial infarction, heart failure, unstable angina, atrial fibrillation, stroke, and cardiovascular death.

A total of 387,439 patients with atopic eczema were matched to 1,528,477 control patients. Median age at study entry was 43 years; 66% of the participants were women. The median follow-up was 5.1 years.

Findings revealed a 10% to 20% increased hazard for the nonfatal primary outcomes for persons with atopic eczema, using Cox regression stratified by matched set. A strong dose-response relationship was observed with respect to severity of atopic eczema. Participants with severe atopic eczema exhibited a 20% increased risk for stroke (hazard ratio [HR], 1.22; 99% CI, 1.01-1.48); a 40% to 50% increased risk for myocardial infarction, unstable angina (HR, 1.48; 99% CI, 1.08-2.03), atrial fibrillation, and cardiovascular death; and a 70% increased risk for heart failure (HR, 1.69; 99% CI, 1.38-2.06).

Furthermore, those patients with the most active atopic eczema (ie, active >50% of follow-up) were also at an increased risk for cardiovascular outcomes. Among patients with the most severe atopic eczema, increased risk for cardiovascular outcomes were observed as well, in particular for unstable angina (HR, 1.49; 99% CI, 1.30-1.72) and heart failure (HR, 1.43; 99% CI, 1.30-1.56).

The investigators concluded that targeting cardiovascular disease prevention strategies among adult patients with severe and/or predominantly active atopic eczema, including awareness of and screening for conventional cardiovascular risk factors by those providing clinical care, is warranted.

Reference

Silverwood RJ, Forbes HJ, Abuabara K, et al. Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study [published online May 23, 2018]. BMJ. doi: 10.1136/bmj.k1786