Cardiovascular and Thromboembolism Risks in Patients With Atopic Dermatitis

Atopic dermatitis (AD) has long been suspected of having implications beyond the skin. A comprehensive cohort study has uncovered compelling evidence suggesting that AD may significantly heighten the risk of atherothrombotic and cardiovascular (CV) disease, as well as venous thromboembolism.

The researchers aimed to provide crucial insights into the potential systemic consequences of AD. The study was conducted using electronic health data spanning 2 decades (1994–2015) from UK general practices. Children (younger than age 18 years) and adults (aged 18 years and older) diagnosed with AD were meticulously matched to patients without AD in terms of age, the same general practice, and encounter date. To gauge the severity of AD, treatments and specialist referrals served as proxies. The study evaluated a spectrum of outcomes, including incident myocardial infarction, cerebrovascular accident (CVA), diabetes, hypertension, dyslipidemia, deep vein thrombosis (DVT), and pulmonary embolism. Statistical analyses, particularly Cox regression, were employed to compare these outcomes between patients with AD and patients without AD.

The study included a substantial cohort, consisting of 409,341 children with AD, primarily classified as mild (93.2%), moderate (5.5%), and severe (1.3%), matched against 1,809,029 unaffected children. For this group, the results were striking. AD was associated with a heightened risk of DVT (hazard ratio [HR] 1.23; 95% CI 1.02–1.48). Severe AD demonstrated a significant association with a higher risk of CVA (HR 2.43; 95% CI 1.13–5.22) and diabetes (HR 1.46; 95% CI 1.06–2.01).

The adult cohort consisted of 625,083 individuals with AD, with the majority classified as mild (65.7%), moderate (31.4%), and severe (2.9%), who were matched against 2,678,888 unaffected adults. For adults, especially those with severe AD, the implications were profound. AD, particularly when severe, was associated with a higher risk of DVT (HR 1.14; 95% CI 1.11–1.18 and HR 1.64; 95% CI 1.49–1.82, respectively) and slightly elevated risks of CVA, diabetes, and dyslipidemia. Notably, adults with severe AD had an increased risk of myocardial infarction (HR 1.27; 95% CI 1.15–1.39), CVA (HR 1.21; 95% CI 1.13–1.30), diabetes (HR 1.15; 95% CI 1.09–1.22), dyslipidemia (HR 1.11; 95% CI 1.06–1.17), and pulmonary embolism (HR 1.39; 95% CI 1.21–1.60) compared to their counterparts without AD.

“Atopic dermatitis, particularly when severe, is associated with small but increased risks of CV risk factors and events and significantly increased risk of venous thromboembolism,” concluded the study authors.

Reference
Wan J, Fuxench ZCC, Wang S, et al. Incidence of cardiovascular disease and venous thromboembolism in patients with atopic dermatitis. J Allergy Clin Immunol Pract. 2023;11(10):3123-3132.e3. doi:10.1016/j.jaip.2023.08.007