Cardiovascular Disease Risk in Patients With Pyoderma Gangrenosum

An ulcer on a man's leg.
An ulcer on a man’s leg.
Patients with pyoderma gangrenosum may benefit from managing modifiable cardiovascular risk factors myocardial infarction, peripheral vascular disease.

Patients diagnosed with pyoderma gangrenosum face an increased risk for myocardial infarction (MI) and peripheral vascular disease (PVD), according to study findings published in the Journal of the European Academy of Dermatology and Venereology.

Researchers aimed to evaluate the risk for and prognostic outcomes of pulmonary embolism (PE), peripheral vascular disease (PVD), cerebrovascular accident (CVA), and myocardial infarction (MI) in patients with pyoderma gangrenosum (PG).

They conducted a population-based retrospective cohort study comparing 302 adult patients with pyoderma gangrenosum with 1497 sex, age, and ethnicity-matched control participants for incident cases of PE, PVD, CVA, and MI. They gathered data from the Clalit Health Services database in Israel. Multivariate Cox regression analysis was used to estimate adjusted hazard ratios (HRs) and CIs.

Researchers observed the overall incidence rates of PE 2.6 (95% CI, 0.8-6.2), PVD 7.5 (95% CI, 3.9-13.0), CVA 8.2 (95% CI, 4.4-13.9), and MI 15.2 (95% CI, 9.5-23.0) per 1000 person-years, respectively.

Researchers observed an increased risk for patients with pyoderma gangrenosum to develop MI (fully-adjusted HR, 2.60; 95% CI, 1.52-4.47; P =.001) and PVD (fully-adjusted HR, 3.15; 95% CI, 1.47-6.76; P =.003). They found the risk for PE (fully-adjusted HR, 3.22; 95% CI, 0.89-11.56; P =.074) and CVA (fully-adjusted HR, 1.66; 95% CI, 0.85-3.22; P =.135) revealed no statistical difference between the control and PG groups.

Compared with the other patients with pyoderma gangrenosum, researchers found those with pyoderma gangrenosum and comorbid MI (HR, 3.07; 95% CI, 1.83-5.14; P <.001) and CVA (HR, 2.24; 95% CI, 1.23-4.08; P =.009) faced increased risk for all-cause death. They noted those with pyoderma gangrenosum and comorbid PVD (HR, 1.81; 95% CI, 0.93-3.49; P =.079) and PE (HR, 1.23; 95% CI, 0.30-5.11; P =.772) did not face the same elevated risk for death.

Researchers lacked matched control groups to significantly evaluate the risk for cardiovascular outcomes in patients with PG, investigators noted.

Study limitations include possible selection and ascertainment biases, eligibility criteria not following the formal diagnostic criteria, lack of data on clinical characteristics and severity of pyoderma gangrenosum, and the homogenous ethnic study population.

Researchers concluded that their study demonstrates that “a diagnosis of [pyoderma gangrenosum] places individuals at an increased risk of MI and PVD.” They suggest efforts to manage modifiable cardiovascular risk factors in patients with pyoderma gangrenosum are worthwhile.

Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Shavit E, Dagan O, Cohen AD, Valdman-Grinshpoun Y, Kridin K. Risk of cardiovascular diseases in pyoderma gangrenosum: a population-based study. J Eur Acad Dermatol Venereol. Published online August 16, 2022. doi:10.1111/jdv.18527