Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis

Andersen, Y.M.F.; Egeberg, Alexander; Gislason, Gunnar; Hansen, Peter Riis; Skov, Lone; Thyssen, Jacob P.

doi:10.1016/j.jaci.2016.01.015

Cited by 107 publications

(131 citation statements)

References 16 publications

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“…Subgroup analyses, although imprecise, indicated no substantial variation of the HR according to the age at AD hospital diagnosis. In the present study, we did not adjust for cardiovascular risk factors emerging after the AD diagnosis, in contrast to the study by Andersen et al ,12 which may explain the stronger association between AD and MI of our study. However, it remains to be clarified, whether these cardiovascular risk factors are part of the pathophysiology of AD, in which case, adjustment would lead to underestimation of the actual impact of AD on MI risk.…”

Section: Discussioncontrasting

confidence: 64%

“…11 Our findings extend the recent report on follow-up of patients with AD from 1997 and onwards, including adjustment for several indicators of cardiovascular risk factors in terms of medication use and hospital diagnoses occurring both before and after AD diagnosis 12. To increase validity, we only included patients with AD with at least two separate hospital diagnoses of AD, and we did sensitivity analyses to evaluate the validity of the AD diagnosis data.…”

Section: Discussionsupporting

confidence: 57%

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Hospital-diagnosed atopic dermatitis and long-term risk of myocardial infarction: a population-based follow-up study

et al. 2016

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ObjectiveAtopic dermatitis (AD) is an inflammatory skin disorder with a childhood prevalence reaching 20%. An estimated 50% of patients have a life-long chronic course. The purpose of this study was to estimate the risk of first-time myocardial infarction (MI) in patients with AD compared with a general population cohort.DesignCohort study.SettingDenmark.ParticipantsUsing population-based medical registries, we identified individuals born in Denmark from 1947 to 1983 with at least two hospital-diagnoses of AD following inpatient admissions or hospital-based outpatient visits at any age from 1977 to 2013. Individuals with AD were matched with general population controls (10:1) for birth-year and gender. Unique personal identifiers permitted unambiguous data linkage.Primary outcome measuresFollow-up began on the date of AD diagnosis (index date for general population controls) and continued until death, emigration, MI or the year 2013. We computed the 15-year-cumulative incidence of MI following a diagnosis of AD. Comparing patients with AD with the general population cohort, we computed HRs of MI presented with 95% CIs and adjusted for history of diabetes mellitus, hypertension, hyperlipidaemia or stroke, educational level, birth-year and sex.ResultsWe identified 4814 patients diagnosed with AD. The cumulative incidence of MI was 0.6% for patients with AD and 0.4% for their matched controls. The corresponding adjusted HR was 1.74 (1.21 to 2.49). The HR for patients who were not in need of systemic treatment was 1.58 (1.02 to 2.45) and it was 2.40 (1.27 to 4.45) for those who were treated with azathioprine, methotrexate or cyclosporine.ConclusionsHospital-diagnosed AD was associated with increased risk of MI compared with the general population.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionsupporting

confidence: 57%

Hospital-diagnosed atopic dermatitis and long-term risk of myocardial infarction: a population-based follow-up study

et al. 2016

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“…(4) A matched cohort study from the Danish general population examined the risk of MI, ischemic stroke and cardiovascular death associated with AD. (6) They stratified AD according to treatments used. Those with topically treated AD had no statistically significant increased risk for cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

“…(1-3) However, there are few, inconsistent epidemiologic studies on AD and cardiovascular events. (4-6) We aimed to determine the association of AD with myocardial infarction (MI) and stroke in a large cohort of US women.…”

Section: Introductionmentioning

confidence: 99%

Atopic dermatitis is not independently associated with nonfatal myocardial infarction or stroke among US women

Drucker

Cho

et al. 2016

Allergy

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We aimed to determine the association between atopic dermatitis (AD) and cardiovascular events in the Nurses' Health Study 2, a cohort of US women. We used logistic regression models to calculate age- and multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between history of AD and non-fatal MI and non-fatal stroke. Of the 78,702 participants in our analysis, 7,916 (10%) had a history of AD. There were 392 and 391 cases of non-fatal MI and stroke, respectively. AD was not associated with MI in age- or multivariate-adjusted analyses. AD was significantly associated with stroke in the age-adjusted analysis (OR 1.38, 95% CI 1.03-1.85). This was no longer significant in multivariate models that adjusted for hypertension, hypercholesterolemia and diabetes (OR 1.31, 95% CI 0.98-1.76) and atopic comorbidities (OR 1.17, 95% CI 0.86-1.58). AD was not independently associated with non-fatal MI or stroke in this study.

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“…A study determining the association between AD and cardiovascular events in the USA revealed that AD was not independently associated with nonfatal MI or stroke [36]. Based on recent studies, lifestyle factors associated with severe AD are likely to explain the apparent increased risk of cardiovascular disease [35-38]. A systematic literature review showed a slightly increased risk of lymphoma in patients with AD.…”

Section: Clinical Presentationmentioning

confidence: 99%

Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019

Simon

Wollenberg

Renz

et al. 2019

Int Arch Allergy Immunol

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Atopic dermatitis (AD) is a chronic inflammatory skin disease presenting with recurrent eczematous lesions and intense pruritus. It is common and affects both children and adults, often beginning in infancy. Due to the unpredictable disease course, its visible skin lesions, itching and scratching followed by sleeplessness, other associated atopic diseases, and behavioral and psychiatric disorders, AD is an immense burden for patients and caregivers. AD is determined by a genetic predisposition characterized by an impaired skin barrier and a T-helper-2-predominant inflammation. Restoration of the skin barrier is the main approach for treating and preventing AD. In order to cope with acute flares, usually topical corticosteroids (TCS) are applied, while topical calcineurin inhibitors (TCI) are used mainly for maintenance therapy. There is a small group of patients who are refractory to TCS and TCI and require systemic immunosuppressive drugs such as ciclosporin. Novel, targeted therapies are under clinical investigation, among which an anti-IL-4/IL-13 receptor antibody has recently been approved in several countries. As we learn to understand the pathomechanisms of AD, the characteristics of the different patient subgroups, and the effectiveness of various targeted therapies, a personalized treatment ensuring the best efficacy and safety and, probably, a disease-modifying effect will result.

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Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis

Cited by 107 publications

References 16 publications

Hospital-diagnosed atopic dermatitis and long-term risk of myocardial infarction: a population-based follow-up study

Hospital-diagnosed atopic dermatitis and long-term risk of myocardial infarction: a population-based follow-up study

Atopic dermatitis is not independently associated with nonfatal myocardial infarction or stroke among US women

Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019

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