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. 2018 May 23:361:k1786.
doi: 10.1136/bmj.k1786.

Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study

Richard J Silverwood  1 , Harriet J Forbes  1 , Katrina Abuabara  2 , Anna Ascott  3 , Morten Schmidt  4   5 , Sigrún A J Schmidt  4 , Liam Smeeth  1 , Sinéad M Langan  6
Affiliations

Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study

Richard J Silverwood et al. BMJ. .

Abstract

Objective: To investigate whether adults with atopic eczema are at an increased risk of cardiovascular disease and whether the risk varies by atopic eczema severity and condition activity over time.

Design: Population based matched cohort study.

Setting: UK electronic health records from the Clinical Practice Research Datalink, Hospital Episode Statistics, and data from the Office for National Statistics, 1998-2015.

Participants: Adults with a diagnosis of atopic eczema, matched (on age, sex, general practice, and calendar time) to up to five patients without atopic eczema.

Main outcome measures: Cardiovascular outcomes (myocardial infarction, unstable angina, heart failure, atrial fibrillation, stroke, and cardiovascular death).

Results: 387 439 patients with atopic eczema were matched to 1 528 477 patients without atopic eczema. The median age was 43 at cohort entry and 66% were female. Median follow-up was 5.1 years. Evidence of a 10% to 20% increased hazard for the non-fatal primary outcomes for patients with atopic eczema was found by using Cox regression stratified by matched set. There was a strong dose-response relation with severity of atopic eczema. Patients with severe atopic eczema had a 20% increase in the risk of stroke (hazard ratio 1.22, 99% confidence interval 1.01 to 1.48), 40% to 50% increase in the risk of myocardial infarction, unstable angina, atrial fibrillation, and cardiovascular death, and 70% increase in the risk of heart failure (hazard ratio 1.69, 99% confidence interval 1.38 to 2.06). Patients with the most active atopic eczema (active >50% of follow-up) were also at a greater risk of cardiovascular outcomes. Additional adjustment for cardiovascular risk factors as potential mediators partially attenuated the point estimates, though associations persisted for severe atopic eczema.

Conclusions: Severe and predominantly active atopic eczema are associated with an increased risk of cardiovascular outcomes. Targeting cardiovascular disease prevention strategies among these patients should be considered.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Flowchart for cohort study, 1998-2015
Fig 2
Fig 2
Association between atopic eczema and cardiovascular outcomes, by severity of atopic eczema versus no eczema. *Adjusted for current calendar period (1997-99, 2000-04, 2005-09, 2010-15), time since diagnosis (0-4, 5-9, 10-14, 15-19, ≥20 years), index of multiple deprivation at cohort entry, and time-varying asthma. †Adjusted additionally for body mass index and smoking at cohort entry, and time-varying hyperlipidaemia, hypertension, depression, anxiety, diabetes, and severe alcohol use
Fig 3
Fig 3
Association between atopic eczema and cardiovascular outcomes, by activity of atopic eczema versus no eczema. *Adjusted for current calendar period (1997-99, 2000-04, 2005-09, 2010-15), time since diagnosis (0-4, 5-9, 10-14, 15-19, ≥20 years), index of multiple deprivation at cohort entry, and time-varying asthma. †Adjusted additionally for body mass index and smoking at cohort entry, and time-varying hyperlipidaemia, hypertension, depression, anxiety, diabetes, and severe alcohol use
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Comment in

References

    1. Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI, ISAAC Phase Three Study Group Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2009;124:1251-8. 10.1016/j.jaci.2009.10.009 - DOI - PubMed
    1. Weidinger S, Novak N. Atopic dermatitis. Lancet 2016;387:1109-22. 10.1016/S0140-6736(15)00149-X - DOI - PubMed
    1. Andersen YM, Egeberg A, Gislason GH, Hansen PR, Skov L, Thyssen JP. Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis. J Allergy Clin Immunol 2016;138:310-12. 10.1016/j.jaci.2016.01.015 - DOI - PubMed
    1. Su VY, Chen TJ, Yeh CM, et al. Atopic dermatitis and risk of ischemic stroke: a nationwide population-based study. Ann Med 2014;46:84-9. 10.3109/07853890.2013.870018 - DOI - PubMed
    1. Drucker AM, Li WQ, Cho E, et al. Atopic dermatitis is not independently associated with nonfatal myocardial infarction or stroke among US women. Allergy 2016;71:1496-500. 10.1111/all.12957 - DOI - PMC - PubMed

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