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

The WHO reclassified stroke in 2006, now a neurological disease not cardiovascular disease.
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Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: Population based cohort study

BMJ — Silverwood RJ, et al. | May 25, 2018

Researchers investigated if adults with atopic eczema are at an increased risk of cardiovascular disease and if the risk varies by atopic eczema severity and condition activity over time. Severe and predominantly active atopic eczema was found to be related to an increased risk of cardiovascular outcomes. Considering targeting cardiovascular disease prevention strategies among these patients was recommended.

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Methods

• In this population based matched cohort study, researchers included adults with a diagnosis of atopic eczema, matched (on age, sex, general practice, and calendar time) to up to five patients without atopic eczema.
• They used UK electronic health records from the Clinical Practice Research Datalink, Hospital Episode Statistics, and data from the Office for National Statistics, 1998–2015, to assess cardiovascular outcomes (myocardial infarction, unstable angina, heart failure, atrial fibrillation, stroke, and cardiovascular death).

Results

• A total of 387,439 patients with atopic eczema were matched to 1,528,477 patients without atopic eczema.
• At cohort entry, the median age was 43 and 66% were female.
• The median follow-up was 5.1 years.
• Cox regression stratified by matched set offered evidence of a 10% to 20% increased hazard for the non-fatal primary outcomes for patients with atopic eczema.
• A strong dose-response association with severity of atopic eczema was found.
• The findings observed in patients with severe atopic eczema included 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).
• A greater risk of cardiovascular outcomes was observed in patients with the most active atopic eczema (active >50% of follow-up).
• The point estimates were partially reduced by additional adjustment for cardiovascular risk factors as potential mediators, though associations persisted for severe atopic eczema.

Read the full article on BMJ