Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

Abstract

Background Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity. Objective We sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes. Methods MEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes. Results Nineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28). Conclusion Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.

Comorbidities and the impact of atopic dermatitis

“…A systematic review and meta-analysis including 19 studies found significantly increased odds of angina in cross-sectional studies, and increased risk of angina, heart failure, ischemic stroke, myocardial infarction, and stroke in longitudinal studies. 114 Thus, the combined effects of available studies indicate modest but significant associations between AD and cardiovascular disease or events. Some of the associations were not significant when applying Bayesian prediction intervals, indicating that the associations may not always occur in individual settings.…”

Update on Atopic Dermatitis

“…9 Potentially under-recognized AD non-allergic comorbidities include cutaneous and extra-cutaneous infections, other autoimmune-or immune-mediated diseases, neuropsychiatric conditions, and emerging comorbidities, such as obesity, cardiovascular and metabolic diseases, as well as specific cancers. 2,[5][6][7]9,13,14,18,25,27 The causative mechanisms underlying these associations are largely unknown, and the absolute magnitude of the risks has not been well defined. 5 Many of these comorbid conditions are directly related to the underlying severity of AD and inadequate disease control.…”

“…2 Although the underlying mechanisms causing these conditions are largely unknown and the absolute magnitude of the risks has not yet been well defined, AD has been considered more recently as a systemic disorder associated with increased risk of various allergic and non-allergic comorbidities, namely food allergies, respiratory disorders, cutaneous and extra-cutaneous infections, neuropsychiatric conditions, other inflammatory and autoimmune diseases, lymphoma, and cardiovascular disease, with important implications for management and treatment. 1,2,5,6,[9][10][11][12][13] Therapeutic goals require a multistep approach, focused on reducing pruritus and establishing disease control. Treatment selection is based primarily on disease severity but also on the patient's age, comorbidities, compliance, and costs.…”

Depression, anxiety and quality of life in subjects with atopic eczema in a population‐based cross‐sectional study in Germany

“…Atopic eczema (AE, atopic dermatitis) is an inflammatory skin disease that affects between 10% and 35% of children while the prevalence in adults is estimated to be around 3–5% in the general population …”

“…Atopic eczema (AE, atopic dermatitis) is an inflammatory skin disease that affects between 10% and 35% of children while the prevalence in adults is estimated to be around 3-5% in the general population. [1][2][3][4][5] Over the last years, there was increasing awareness on nonatopic comorbidities in patients with AE. 2 Data on comorbidities were shown to differ between geographical regions, that is with regard to cardiovascular comorbidities registered in US but not in European subjects with AE.…”