P ECZEMA X INCR CV RISKS

Atopic Eczema and Major Cardiovascular Outcomes

The Journal of Allergy and Clinical Immunology

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TAKE-HOME MESSAGE

• This systematic review used data from 19 studies to examine the relationship between atopic eczema and major cardiovascular outcomes, of which 17 studies were used for meta-analyses. No consistent evidence for pooled associations was found in cross-sectional studies, which were very heterogeneous. However, analyses of data from cohort studies found increased risks of cardiovascular outcomes (stroke, ischemic stroke, angina, heart failure, and myocardial infarction) associated with atopic dermatitis (AD). Additionally, there was an increasing trend toward risk of developing cardiovascular disease with increasing AD severity, demonstrating a dose–response relationship.

• Increasing AD severity may increase the risk of cardiovascular events. While further high-quality evidence is needed, data from this systematic review and meta-analysis suggests that patients with moderate to severe AD may benefit from early cardiovascular disease prevention.

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

To systematically review and meta-analyse 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 multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes.

RESULTS

19 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 1.12, 95% confidence interval (CI) 1.00 to 1.25); stroke (n=4), (1.10, 1.03 to 1.17;); ischaemic stroke (n=4), (1.17, 1.14 to 1.20; angina (n=2), (1.18, 95% CI 1.13 to 1.24); and heart failure (n=2), (1.26, 95% CI 1.05 to 1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of developing cardiovascular outcomes appeared to increase with increasing severity (mean relative risk increase between severity categories 1.15, 95% credibility interval 1.09 to 1.21, uncertainty interval 1.04 to 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 amongst stakeholders regarding this small significant association is warranted.