Increased risk of subclinical atherosclerosis and metabolic syndrome in patients with vitiligo: a real association or a coincidence?

Abstract

Inflammatory and autoimmune skin diseases such as vitiligo may be associated with systemic disorders, including endocrine and cardiovascular diseases, due to some similarities in the pathogenesis. It was aimed to evaluate metabolic syndrome and subclinical atherosclerosis in patients with vitiligo. Seventy patients with nonsegmental vitiligo and 70 age-matched and gender-matched healthy controls participated in the study. These participants were investigated for metabolic syndrome criteria. The mean intima-media thickness of the common carotid artery (MIMT-CCA) of the subjects was measured for assessment of subclinical atherosclerosis. Metabolic syndrome and subclinical atherosclerosis were significantly more frequent in vitiligo patients compared with the controls (P = .006 and P = .002, respectively). In addition, metabolic syndrome and subclinical atherosclerosis had positive, significant correlations with the severity and duration of vitiligo (P = .031 and r = .482; P < .01, respectively). Our study suggested that patients with vitiligo, especially those with more chronic and severe disease or concomitant metabolic syndrome, are at a higher risk of developing cardiovascular diseases. Therefore, early diagnosis and treatment of metabolic syndrome in patients with vitiligo to prevent cardiovascular complications were recommended. K E Y W O R D S atherosclerosis, cardiovascular diseases, intima-media thickness of the common carotid artery, metabolic syndrome, vitiligo 1 | INTRODUCTION Vitiligo is an acquired skin disease characterized by the loss of functional melanocytes and the depigmentation of the skin and/or mucous membranes. The pathogenesis of vitiligo is not well known, though research has indicated the role of both genetic and environmental factors through a complex combination of inflammatory, immunologic, oxidative stress, and neural mechanisms. 1-3 Vitiligo may be associated with other autoimmune diseases such as autoimmune thyroid disease, inflammatory bowel disease (IBD), pernicious anemia, rheumatoid arthritis, systemic lupus erythematosus (SLE), Addison disease, and type 1 diabetes mellitus (DM). 1,2,4 In addition, some studies have reported an increased incidence of type 2 DM, dyslipidemia, and metabolic syndrome in vitiligo patients. 5 Proinflammatory cytokines that contribute to the pathogenesis of vitiligo such as tumor necrosis factor (TNF)-α and interleukin (IL)-1 and IL-6 are known to have a role in the development of insulin resistance as well as atherosclerosis. 6 Nastaran Namazia and Maliheh Amani contributed equally to this study.

Study of metabolic syndrome in patients of Vitiligo: A single-center observational study

“…14 The difference observed in proportions of MetS found between present study and reference study can be attributed to difference in prevalence of MetS or the risk factors of MetS between the geographic region of the present and reference study as the proportion of MetS in control group was also high in the reference study. However Namazi et al, 15 observed higher prevalence of MetS (34.3%) as compared to our study, which could be attributed to difference in diagnostic criteria of MetS, our study used NCEP ATP III criteria whereas reference study used NHLBI and AHA guidelines.…”

Association between vitiligo and metabolic syndrome: A systematic review and meta‐analysis

“…Decreased numbers of melanocytes impair their anti-inflammatory and antioxidative functions, which may predispose patients to develop metabolic syndrome [3,7]. Consistent with our findings, previous studies have identified a significantly greater thickness of common carotid intima-media in patients with vitiligo than that in the control groups, indicating an increased risk of atherosclerosis [6,7].…”

Metabolic Comorbidities in Vitiligo: A Brief Review and Report of New Data from a Single-Center Experience

“…Moreover, the researchers performed high-resolution ultrasonography to assess the intima-media thickness of the common carotid artery as a marker of subclinical atherosclerosis. Overall, vitiligo patients showed higher frequencies of subclinical atherosclerosis than healthy subjects [60].…”