Are Adults with Atopic Dermatitis at an Increased Risk for Cardiovascular Disease?

Atopic dermatitis, also called atopic eczema, is a chronic, especially severe form of eczema, which is a common condition of the skin.1 Both are characterized by distinctive patches of scaly dry skin, inflammation, redness, and itching. AD is a chronic, relapsing condition. People with AD experience ongoing, periodic “flares,” when symptoms become more severe, followed by periods of relief when symptoms are reduced. Data shows that atopic dermatitis affects up to 25% of children and around 7% of adults.2

The causes of atopic dermatitis are not fully understood, but it is thought to originate from a combination of genetic and environmental factors.3 According to researchers, it is likely to result from an overactive immune system responding abnormally strongly to minor triggers or irritants. The result is an overproduction of immune factors and inflammation, which are responsible for the redness, swelling, and itching that are common in people with atopic dermatitis.

Higher rates shown in some studies

Given that atopic dermatitis also involves systemic inflammation, multiple investigations have focused on the connection between atopic dermatitis and heart disease. Several studies have in fact shown elevated rates of cardiovascular disease, heart attack, and stroke among adults with the condition.4,5

Other conditions that sometimes are confused with atopic dermatitis have been shown to have a link between cardiovascular issues, one such condition is psoriasis. Because psoriasis is a systemic autoimmune disease that causes inflammation throughout the body, researchers have been interested in its connection with heart disease and other health problems that might also result from systemic inflammation. In 2006, a landmark study showed that people with psoriasis have higher rates of heart attack than the general population.4

Inconsistent results shown in some studies

However, more recently, multiple studies focusing on different populations in different countries have produced inconsistent results.

One confounding factor is that people with atopic dermatitis, which can negatively affect lifestyle, have higher rates of smoking, alcohol use, obesity, depression, hypertension, and sedentary habits.6 These are all independent risk factors for cardiovascular disease, heart attack, and stroke. Therefore, any studies that examine the connections between heart disease and atopic dermatitis must account for these lifestyle differences.

No connection shown in some studies

Investigations of larger study populations are generally more accurate than smaller studies. One particularly large population-based study was recently conducted in the Netherlands. The researchers examined more than 29,000 Danish adults with atopic dermatitis and more than 145,000 controls to determine if they could find a correlation between the skin condition and heart disease.6

In the end, the researchers did find such a connection, but it was explained entirely by the higher levels of lifestyle-based risk factors (such as smoking or obesity) that people with atopic dermatitis experience. In fact, people with mild (vs. severe) cases actually had lower levels of cardiovascular problems. 6

Another equally large population study among more than 259,000 Canadians also failed to attribute higher rates of cardiovascular disease to atopic dermatitis.7

The importance of managing risk factors

This is good news for people living with atopic dermatitis. However, it does suggest that people experiencing this condition should work regularly with their healthcare providers to adopt healthy lifestyle practices and manage their independent cardiovascular risk factors.

View References
  1. What is the Difference between Eczema and Atopic Dermatitis? National Eczema Association. https://nationaleczema.org/eczema/ Accessed March 15, 2018.
  2. Robert Sidbury, Dawn M. Davis, David E. Cohen, et. al., Guidelines of Care for the Management of Atopic Dermatitis. Journal of the American Academy of Dermatology. August 2014; 71(2): 327–349. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410179/#S12title. Accessed March 15, 2018.
  3. Atopic Dermatitis-Eczema. The Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273. Published March 6, 2018. Accessed March 15, 2018.
  4. Kasper Fjellhaugen Hjuler, Morten Böttcher, Christian Vestergaard, Mette Deleuran, et. al. Increased Prevalence of Coronary Artery Disease in Severe Psoriasis and Severe Atopic Dermatitis. The American Journal of Medicine. December 2015; Vol 128, No. 12: 1325-1334. Available from http://www.amjmed.com/article/S0002-9343(15)00545-8/pdf. Accessed April 5, 2018.
  5. J. I. Silverberg. Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population‐based studies. Allergy. 2015; 70: 1300-1308. Accessed March 5, 2018.
  6. Yuki M.F. Andersen, Alexander Egeberg, Gunnar H. Gislason, et. al. Risk of myocardial infarction, ischemic stroke, and cardiovascular death in patients with atopic dermatitis. Journal of Allergy and Clinical Immunology. July 2016. Volume 138, Issue 1, Pages 310–312.e3. Available at: http://www.jacionline.org/article/S0091-6749(16)00199-8/fulltext Accessed April 5, 2018.
  7. Brown University. "Study casts doubt about link between eczema, cardiovascular disease." ScienceDaily, 16 June 2017. Available at https://www.sciencedaily.com/releases/2017/06/170616102159.htm. Accessed March 5, 2018.

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