Underlying inflammation is implicated in both rosacea and the cardiometabolic syndrome, a pro-inflammatory state characterized by cardiovascular (CV) risk factors such as insulin resistance and hypertension, suggesting dermatologists who see patients with rosacea should evaluate whether these patients also have underlying risk factors that predispose them to CV disease. This is according to findings from a literature review published in the Journal of Cosmetic Dermatology.
The review included studies that described metabolic syndrome, rosacea, drugs, hypertension, flushing, smoking, and obesity and were published in the PubMed, MEDLINE, and EMBASE databases. All literature published from the date of database establishment to June 18, 2020, were eligible for inclusion in the review.
Several studies reported chronic inflammation as an underlying feature in both rosacea and cardiometabolic disease. In addition, many studies suggested that metabolic symptoms are associated with elevated levels of C-reactive protein (CRP), a feature also observed in studies of patients with severe rosacea. Although metabolic syndrome was characterized as a pro-inflammatory state, rosacea was often associated with low-grade systemic inflammation. The low-grade inflammation in rosacea, according to some evidence the investigators found, may explain the frequent reports of high levels of total cholesterol, low-density lipoprotein, and CRP in all rosacea subtypes.
The evidence did find associations between rosacea, hypertension, and dyslipidemia, yet there was a lack of evidence to support an association between rosacea and ischemic heart disease. A case-control study found that patients with rosacea had an increased risk for hypertension, dyslipidemia, and coronary artery disease. Carotid intima-media thickness and epicardial fat thickness are significantly higher in patients with rosacea, according to some studies.
Also, some evidence points to higher rates of insulin resistance and obesity in patients with rosacea. Few conclusive data have supported a link between rosacea and smoking. Some studies suggest past smokers have an increased risk for rosacea, whereas current smokers have a reduced risk for the disease compared with never-smokers. The investigators of the review postulate that smoking induces vasoconstriction and reduces flushing, which may explain the lower incidence of rosacea in current-smokers.
“Clinicians treating rosacea patients should consider whether there are underlying cardiovascular risk factors and investigate and treat these accordingly for the patients’ holistic health,” the review investigators wrote.
Searle T, Al-Niaimi F, Ali FR. Rosacea and the cardiovascular system [published online July 3, 2020]. J Cosmet Dermatol. doi: 10.1111/jocd.13587