Abstract
BackgroundAtopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity.ObjectiveWe sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes.MethodsMEDLINE, 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.ResultsNineteen 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).ConclusionSignificant 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.
Highlights
Atopic eczema is a common inflammatory skin disease
Seven studies assessed the risk of cardiovascular outcomes by atopic eczema severity, with 6 of these studies defining atopic eczema severity by use of systemic treatments[10,12,19,23,28] and 1 study using number of dermatology visits as a proxy for severity.[11]
Misclassification bias could account for an increased risk of cardiovascular outcomes in patients with atopic eczema because those with severe disease are often defined by receiving systemic therapies, for most of the outcomes studies, this is not likely to be a particular issue because we have focused on major cardiovascular outcomes that are likely to present for care
Summary
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. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes. 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 5 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n 5 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n 5 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n 5 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n 5 2; RR, 1.26; 95% CI, 1.05-1.51). Conclusion: Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Improved awareness among stakeholders regarding this small but significant association is warranted. (J Allergy Clin Immunol 2019;143:1821-9.)
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