Acta Dermato-Venereologica 99-10CompleteContent | Page 9

CLINICAL REPORT 865 Association Between Atopic Dermatitis and Cardiovascular Disease: A Nationwide Register-based Case-control Study from Sweden Lina U. IVERT 1,2 , Emma K. JOHANSSON 1,3 , Henrik DAL 4,5 , Bernt LINDELÖF 1,2 , Carl-Fredrik WAHLGREN 1,2 and Maria BRADLEY 1,2 Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, 2 Department of Dermatology, Karolinska University Hospital Solna, 3 Dermatological and Venereal Clinic, Södersjukhuset, 4 Department of Public Health Sciences, Karolinska Institutet, and 5 Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden 1 The associations between atopic dermatitis (AD) and cardiovascular disease (CVD) are debated. The aim of this study was to investigate the association between AD and coronary artery disease or ischaemic stroke in a nationwide, register-based, case-control study (104,832 AD cases, 1,022,435 controls) based on link­ age of Swedish national register data between 1968 and 2016. Patients were classified as having severe AD if they had received systemic pharmacotherapy for AD or had been treated in a dermatological ward with AD as the main diagnosis. Other AD was classified as non-severe. After multivariable adjustments for co- morbidities and socioeconomic status, overall AD was associated with angina pectoris (adjusted odds ratio (aOR) 1.13, 95% confidence interval (CI) 1.08–1.19), but among males with severe AD this association was not found, compared with the general population. Male non-severe AD was associated with myocardial infarc- tion (OR 1.15, 95% CI 1.07–1.23). Severe AD was as- sociated with ischaemic stroke, with similar estimates in men and women (aOR 1.19, 95% CI 1.07–1.33). Subgroup analyses among women indicated smoking as an important risk factor among severe cases. Dia­ betes mellitus, hyperlipidaemia, and hypertension were more prevalent in severe AD than in controls, and hyper­lipidaemia and hypertension were also more prevalent in non-severe AD than in controls. In conclu- sion,  in this study, AD was associated with CVD,  and this should be kept in mind, especially when managing patients with severe AD. Key words: angina pectoris; atopic dermatitis; coronary artery disease; comorbidity, eczema; myocardial infarction; stroke. Accepted Jun 13, 2019; E-published Jun 14, 2019 Acta Derm Venereol 2019; 99: 865–870. Corr: Lina U. Ivert, Department of Dermatology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. E-mail: [email protected] A topic dermatitis (AD) is a common chronic inflam- matory skin disorder with a lifetime prevalence of 10–20% in developed countries (1, 2). The pathogenesis of AD is complex, with interactions of multiple genetic, biological and environmental factors leading to skin barrier dysfunction and altered immunological response. AD can have a severely negative impact on health-related quality of life, including self-confidence and sleep, and it also implies a socioeconomic burden, with loss of work­ ing days and extensive use of healthcare resources (3). SIGNIFICANCE Studies show conflicting results regarding the association between atopic dermatitis and cardiovascular disease. The aim of this study was to investigate the association bet- ween atopic dermatitis and angina pectoris, myocardial infarction, or ischaemic stroke in a nationwide, register- based, case-control study among Swedish patients aged 15 years or older. Adult patients with atopic dermatitis were found to have a positive association with angina pectoris, myocardial infarction, and ischaemic stroke, compared with the general population. The association between atopic dermatitis and cardiovascular disease was attenuated after adjustment for cardiovascular comorbidities and education. Associations between AD and atopic comorbidities, such as asthma, allergic rhinitis, and food allergies, are well-established (1). In recent years, several studies have explored associations between AD and non-atopic comorbidities; for example, cardiovascular disease. It has been suggested that the chronic systemic inflam- mation in patients with AD may trigger arteriosclerosis and cardiovascular disease, in line with the observed risks among patients with psoriasis (4, 5). However, a meta-analysis using adjusted effect estimates reported no association between AD and myocardial infarction, hy- pertension, diabetes mellitus, or stroke, although a modest association with angina pectoris was found. The authors concluded that variations in risk factors, such as obesity and smoking, might explain positive associations in dif- ferent populations, and that AD is unlikely to represent an independent risk factor for cardiometabolic disease (6). On the other hand, most of the studies included were cross-sectional and, in some, the AD diagnosis was based on questionnaires not specific for AD. Furthermore, in a large population-based study from the UK, patients with severe AD had a significantly higher risk of stroke and cardiac outcomes (7). Also, a recent systematic review and meta-analysis found that significant associations between AD and cardiovascular outcomes were more common in cohort studies, but with between-study hete- rogeneity, and that increasing AD severity was associated with cardiovascular outcomes (8). Thus, in summary, epidemiological studies have shown conflicting results. The aims of this study, using well-established nation- wide Swedish healthcare registries, were to assess the association between AD at age 15 years or older and This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3235 Acta Derm Venereol 2019; 99: 865–870