Potential Predictors of Cardiovascular Risk Improvement in Patients with Hidradenitis Suppurativa Treated with Adalimumab: A Pivotal Study of Factors Associated with Carotid Intima–Media Thickness Reduction

Abstract

Introduction: Hidradenitis suppurativa (HS) has been linked to higher cardiovascular risk (CVR) due to its inflammatory burden. There is little evidence on how biologic treatment could modify the cardiovascular risk of patients with HS. The aims of the present study were to explore the modification of CVR in patients under adalimumab treatment and to explore the potential factors associated with CVR improvement. Methods: A prospective longitudinal study was performed. A cohort of patients with HS treated with adalimumab was followed up. Carotid intima-media thickness (IMT) and other clinical and biochemical CVR factors were collected at baseline and 32 weeks after starting the treatment.Results: Twenty-seven patients with severe HS were included. Overall, there were no differences in IMT between baseline (633 lm) and 32 weeks follow-up (634 lm). However, 40.7% (11/27) of the patients presented an improvement in IMT. This group (IMT responders) had a higher prevalence of dyslipidemia, diabetes mellitus, higher HbA1c levels, consumed more tobacco, and had higher BMI at baseline. Moreover, these patients had lower IHS4 scores at baseline and tended to have a greater IMT basal value, indicating a higher burden of subclinical atherosclerosis. Conclusions: Adalimumab treatment might benefit a subset of patients with HS in terms of cardiovascular risk reduction. In light of the results of the present study patients with classical cardiovascular risk factors, and those with higher burden of subclinical atherosclerosis and with less inflammatory load, may be more likely to improve their IMT during adalimumab treatment.

Investigating Adiposity-Related Metabolic Health Phenotypes in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

“…A higher prevalence of subclinical atherosclerosis as assessed by carotid artery intima thickness (cIMT), independent of classical cardiovascular risk factors, has also been reported in HS [38,39]. Longitudinal studies show that adalimumab confers beneficial cardiovascular risk with a reduction in cIMT in a subset of HS patients exhibiting classical metabolic risk factors [40]. This further reinforces the need for stratified cardiovascular risk management in HS, as cIMT non-responders to adalimumab exhibited a different HS phenotype.…”

Cardiovascular disease and hidradenitis suppurativa: inflammation beyond the skin

“…HS is a dermatological disease that can irreversibly destroy the skin, but as we have seen, it can also affect the cardiovascular system. Current therapeutic goals consider treatment success the reduction of inflammatory lesions (abscesses and inflammatory nodules) by 50–55% 5 . But what about the other half of the inflammatory burden we do not control?…”