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Meta-Analysis
. 2019 May;143(5):1821-1829.
doi: 10.1016/j.jaci.2018.11.030. Epub 2018 Dec 18.

Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

Anna Ascott  1 , Amy Mulick  2 , Ashley M Yu  3 , David Prieto-Merino  2 , Morten Schmidt  4 , Katrina Abuabara  5 , Liam Smeeth  2 , Amanda Roberts  6 , Sinéad M Langan  2
Affiliations
Meta-Analysis

Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

Anna Ascott et al. J Allergy Clin Immunol. 2019 May.

Abstract

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: We sought to systematically review and meta-analyze 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 a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes.

Results: Nineteen 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 [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28).

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 among stakeholders regarding this small but significant association is warranted.

Keywords: Atopic eczema; angina; atopic dermatitis; cardiovascular death; cardiovascular outcomes; heart failure; ischemic stroke; myocardial infarction; risk factors; stroke.

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Figures

Fig 1
Fig 1
PRISMA flow chart: results of the search strategy.
Fig 2
Fig 2
Forest plots of cross-sectional studies estimating the association between atopic eczema and angina, heart failure, myocardial infarction, and stroke. Box sizes are proportional to study weighting in the random-effects meta-analysis, where larger boxes indicate greater precision. NHANES, National Health and Nutrition Examination Survey; NHIS, National Health Interview Survey.
Fig 3
Fig 3
Forest plots of longitudinal cohort studies estimating the association between atopic eczema and the risk of angina, heart failure, myocardial infarction, stroke, or ischemic stroke. Box sizes are proportional to study weighting in the random-effects meta-analysis, where larger boxes indicate greater precision.
Fig 4
Fig 4
RR of cardiovascular outcomes (compared with subjects without atopic eczema) plotted against atopic eczema severity. A, Observed associations with CIs in each study and lines connecting within-study estimates. B, Estimated relative increase in risk (ie, slope) for each outcome with 95% CrIs. CV, Cardiovascular; MI, myocardial infarction.
See this image and copyright information in PMC

Comment in

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