Support for increased cardiovascular risk in non‐segmental vitiligo among Egyptians: A hospital‐based, case–control study

Abstract

Background Data have been accumulating in the past few years that identify vitiligo as a disorder with systemic implications. Results and methods In this hospital‐based, cross‐sectional, case–control study, 50 patients with non‐segmental vitiligo and 50 age‐ and sex‐matched controls underwent analysis of serum lipid profile, oxidative stress biomarkers and carotid duplex. Hydrogen peroxide (H2O2) and malondialdehyde (MDA) were significantly higher in patients than controls (p‐value < .001, <.001, respectively); on the other hand, total antioxidant capacity (TAC) was significantly lower in patients than controls (p‐value = .001). A significantly higher percentage of patients had hypercholesterolemia and borderline high, high or very high levels of LDL‐C, compared to controls (p‐value = .001 and .001, respectively). Atherosclerotic plaques and increased common carotid intima media thickness were significantly detected in patients versus controls. Discussion Results of the present study suggest that a subset of patients with vitiligo are at a higher risk of developing dyslipidemia and atherosclerosis, which might increase their future risk for the development of cardiovascular disease. Confirmation of these findings would subsequently influence investigative and the treatment strategies in the management plan of vitiligo patients in the near future. Significance Vitiligo patients might be at a higher risk of developing dyslipidemia and atherosclerosis, which might increase their risk for the development of cardiovascular disease necessitating prophylactic measures to improve prognosis. Our results might influence the investigative and treatment strategies in the management plan of vitiligo patients in the near future.

Clinical Significance of Serum Oxidative Stress Markers to Assess Disease Activity and Severity in Patients With Non-Segmental Vitiligo

“…OS is characterized by the excessive accumulation of oxidation products and inadequate antioxidants ( Chen et al, 2021 ). There is numerous evidence that patients with vitiligo have increased oxidation product like the lipid oxidation product malondialdehyde (MDA) and the oxidative DNA damage byproducts [8-hydroxy-2-deoxyguanosine (8-OHdG)] ( Wei et al, 2013 ; Vaseghi et al, 2017 ; Azzazi et al, 2021 ). In addition, patients with vitiligo have down-regulated enzymes, such as catalase (CAT) ( Agrawal et al, 2014 ) and dysregulated superoxide dismutase (SOD) ( Koca et al, 2004 ; Khan et al, 2009 ; Ozel Turkcu et al, 2014 ), and abnormal non-enzyme defense to oxidants like the total antioxidant capacity (TAC) ( Hayran et al, 2021 ).…”

Vitiligo: The Association With Metabolic Syndrome and the Role of Simvastatin as an Immunomodulator

“…Oxidative stress has been a notorious factor involved in the development of various diseases, including vitiligo and metabolic syndrome, through the generation of reactive oxygen species (ROS). ROS plays a vital role in cellular events such as inflammatory response, cell growth alteration, and apoptosis [ 12 ]. Enzymatic and non-enzymatic antioxidants such as superoxide dismutase, glutathione peroxidase, and catalase are present in melanocytes whose primary function is to prevent oxidative damage.…”

“…Koca et al, in their study, showed excess free radical generation leading to peroxidative damage mediated by increased oxidative destruction of polyunsaturated fatty acid of phospholipids [ 14 ]. This oxidative destruction was supported by increased levels of malondialdehyde (MDA) and H 2 O 2 [ 12 , 14 , 15 ]. Azzazi et al and Khan et al also found decreased total antioxidant capacity in patients compared to controls.…”

“…Azzazi et al and Khan et al also found decreased total antioxidant capacity in patients compared to controls. They found a significant association between carotid intima-media thickness and MDA levels [ 12 , 15 ]. A study by Bhatti et al mentioned that oxidative stress caused the deposition of ROS in cells and tissues, leading to mitochondrial dysfunction by interacting with mitochondrial and cellular components such as DNA, protein, and lipids [ 16 ].…”

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

“…Karadag et al are concordant with the abovecited papers, showing lower HDL concentration, increased LDL/HDL ratio, and higher insulin resistance as measured with homeostatic model assessment-IR (HOMA-IR) [62]. A recent study by Azzazi et al has shown that a subset of patients with vitiligo is at a higher risk of developing dyslipidemia and atherosclerosis, which might increase their future risk for the development of cardiovascular disease, by means of analysis of the serum lipid profile, oxidative stress biomarkers, and carotid duplex [63]. The possible alterations of the lipid profile seem not to be limited to adults as Pietrzak et al have shown increased LDL, decreased HDL, and increased LDL/HDL ratio and triglycerides in vitiligo-affected children [64].…”