BMJ: Severe
eczema in adults is associated with a moderately increased risk of
cardiovascular problems (conditions affecting the heart and blood
vessels) including heart attacks, stroke, and irregular heart rate,
finds a UK study published by The BMJ today. This
is the largest study to date to assess the association between atopic
eczema and major cardiovascular events, and the researchers say their
findings support the consideration of targeted screening and focus on
prevention strategies among these patients.
There
is growing evidence that people with severe chronic inflammatory
diseases, such as rheumatoid arthritis and severe psoriasis, may be at
higher risk of cardiovascular disease (CVD), independent of more
traditional risk factors.
Eczema
(also known as atopic eczema) is a common inflammatory condition that
affects up to 10% of adults. Previous studies on the risk of CVD in
patients with atopic eczema have reported mixed results, but given how
common it is, even a small increase in risk would be important from a
public health perspective.
So
an international research team led by Sinéad Langan at the London
School of Hygiene & Tropical Medicine, set out to investigate
whether adults with atopic eczema are at an increased risk of
cardiovascular disease and whether the risk varies by eczema severity
and activity over time.
They
analysed data from the UK’s Clinical Practice Research Datalink for
over 385,000 adults (average age 43 years) with atopic eczema, matched
with up to five patients of similar age and sex, but without eczema.
Patients were classified as having mild, moderate or severe atopic eczema and were monitored for an average of five years.
During
this time, major cardiovascular events were recorded – heart attack
(myocardial infarction), unstable angina, heart failure, irregular
heartbeat (atrial fibrillation), stroke and cardiovascular death.
After
taking account of known cardiovascular risk factors, such as weight
(BMI), smoking and alcohol intake, the researchers found that patients
with severe eczema were at a 20% increased risk of stroke, 40% to 50%
increased risk of unstable angina, myocardial infarction, atrial
fibrillation, and cardiovascular death, and almost 70% increased risk of
heart failure.
The risk was greater for patients with severe or more active eczema.
This
is an observational study, so no firm conclusions can be drawn about
cause and effect, and the authors outline some limitations, such as
possible misclassification of eczema severity. Nevertheless, the study
was large and the authors were able to account for other potentially
influential risk factors.
As
such, they conclude: “Severe and predominantly active atopic eczema are
associated with an increased risk of cardiovascular outcomes. Targeting
cardiovascular prevention strategies among these patients should be
considered.”
In
a linked editorial, John Ingram, consultant dermatologist at Cardiff
University, says these results have helped to clarify the conflicting
evidence regarding atopic eczema and CV risk, and make the case for
targeted screening of standard cardiovascular disease risk factors.
The
results may also have ramifications for allocation of healthcare
resources in eczema, through use of expensive next generation biologic
drugs to better control severe eczema, he adds. Exploring whether these
eczema drugs reduce CV events in patients with severe eczema is the next
important step, he concludes.
[Ends]
Editorial: Atopic eczema and cardiovascular disease
Journal: The BMJ