From the Journals

Atopic eczema linked to cardiovascular disease risk


Key clinical point: Severe atopic eczema may be associated with a significantly increased risk of cardiovascular disease.

Major finding: Individuals with severe atopic eczema were at increased for cardiovascular disease, including a 67% greater risk of heart failure.

Study details: A population-based case-control cohort study in 387,439 patients with atopic eczema, compared with more than 1 million controls.

Disclosures: The study was supported by the Wellcome Trust, and no relevant conflicts of interest were declared.

Source: Silverwood R et al. BMJ. 2018 May 23;361:k1786.

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Eczema: Another inflammatory condition linked to CVD

The evidence in favor of a link between chronic inflammatory conditions, such as rheumatoid arthritis, and cardiovascular disease is growing. However, there are conflicting data and some of the uncertainty may be a result of a dose-response effect, where the increased cardiovascular risk is seen only in people with more severe disease.

This study and its finding of increased cardiovascular risk in patients with severe or more active eczema supports the case for targeted screening of this group for standard cardiovascular disease risk factors. It also could prompt incorporation of severe eczema as an independent cardiovascular disease risk factor in calculation of thresholds for primary prevention interventions.

The findings also may have implications for health care resources allocated to treatment of eczema, as prevention of cardiovascular disease could contribute to the argument in favor of the more expensive next-generation biologic treatments for eczema that are becoming available.

John R. Ingram, MD, is senior lecturer and consultant dermatologist, dermatology and academic wound healing in the division of infection and immunity at Cardiff (U.K.) University. These comments are taken from an accompanying editorial No conflicts of interest were declared. (BMJ. 2018 May 23. doi: 10.1136/bmj.k2064).



Severe atopic eczema could significantly increase the risk of cardiovascular disease, including stroke and heart failure, according to a case-control study published online May 23 in BMJ.

In a population-based cohort study, researchers compared the electronic health records of 387,439 adults with eczema and 1,528,477 patients without eczema in the United Kingddom, matched according to age, sex, general practice, and calendar time, during 1998-2015. Patients were followed up for a median of 5.1 years

With the exception of cardiovascular death, atopic eczema was associated with all cardiovascular outcomes (MI, unstable angina, heart failure, atrial fibrillation, and stroke). The associations were stronger for severe atopic eczema, with significantly higher risks of MI, unstable angina, atrial fibrillation, stroke, cardiovascular death, and coronary revascularization among individuals with severe atopic eczema, compared with controls.

After adjustment for potential mediators such as body mass index, smoking, hyperlipidemia, diabetes, and severe alcohol use, individuals with severe eczema had a significant 37% increased risk of MI, 67% greater risk of heart failure, 35% greater risk of atrial fibrillation, 30% greater risk of cardiovascular death, and 36% greater risk of coronary revascularization, compared with controls with no eczema.

Increased cardiovascular risks also were seen in individuals whose atopic eczema was active more than half the time at follow-up. This group had a 37% greater risk of heart failure, 36% greater risk of unstable angina, and 19% greater risk of stroke, as well as significantly elevated risks of MI, atrial fibrillation, cardiovascular death, and coronary revascularization, compared with those without eczema.

Overall, atopic eczema contributed around 2.4% of the population-attributable risk for unstable angina, and 1.9% for heart failure (the highest population attributable risks). Ethnicity or high-dose corticosteroid use did not significantly impact outcomes.

Richard J. Silverwood, PhD, from the London School of Hygiene and Tropical Medicine, and his coauthors wrote that previous work examining the relationship between atopic eczema and cardiovascular disease had shown inconsistent outcomes, with some studies even pointing to a possible protective effect of mild atopic eczema.

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