Cardiovascular risk factors and confounders in severe atopic dermatitis: a scoping review

Fabiola Welter Ribeiro,Emilton Lima Junior

doi:10.33448/rsd-v11i3.26926

Abstract

Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease that could be associated with cardiovascular diseases (CVDs). Interest in determining whether the chronic inflammation of AD is a risk factor for CVD has been growing in recent years, although there are few studies available on this topic, and the results are quite controversial. The purpose of this scoping review was to understand whether severe atopic dermatitis and its chronic systemic inflammatory process contribute, or not, as a risk factor for the development of CVD. Following the development of a study protocol, a scoping review was carried out based on the structure outlined by Arksey and O'Malley, Levac et al., the Joanna Briggs Institute and the PRISMA-ScR guidelines. PubMed, Cochrane, EMBASE, CINAHL, LILACS, Web of Science, Biblioteca Virtual em Saúde (BVS), Scopus and SciELO were the selected databases. Results: Fifty-two studies were included in this review (18 review studies, 16 cross-sectional studies, 15 cohort studies and three meta-analyses). We found that 36 studies could associate AD with CVD, while 16 studies found no relationship between AD and CVD. Conclusions: It is possible that cardiovascular risk in moderate to severe atopic disease is in confounding factors, and not necessarily because AD and CVDs share the same chronic systemic inflammatory pathway. There is no robust evidence that AD is a risk factor for CVD. To reduce CVD risk in patients with AD, we must pay attention to the risk factors commonly present in these patients and strongly recommend a healthy lifestyle.

Highlights

Atopic dermatitis (AD) is a chronic and recurrent inflammatory disease that affects the skin surface
Alcoholism, smoking, dyslipidaemia, sleep disorders, metabolic syndrome, mood disorders, obesity, overweight, physical inactivity, and diabetes, which are known to be factors predisposing to Cardiovascular diseases (CVDs), are present in most AD patients and are considered confounding factors.(Ali et al, 2018) Most comorbidities associated with AD are apparently caused by the interaction between genetic predisposition, environmental exposure, chronic inflammation due to AD, medication use and lifestyle.(Andersen et al, 2017)
There are contradictory results, together, these findings suggest that an increase in risk factors for CVD and poor health behaviour, lifestyle factors such as smoking, drinking and physical inactivity, may be important factors for cardiovascular events instead of considering only the systemic inflammation associated with AD

Summary

Introduction

Atopic dermatitis (AD) is a chronic and recurrent inflammatory disease that affects the skin surface. It has a multifactorial aetiology involving genetic factors and immunological and non-immunological changes. 2017; Oliveira et al, 2019; Sehra et al, 2008; Silverwood et al, 2018) In recent years, it has been discussed whether AD is an exclusively cutaneous disease or whether it is a systemic inflammatory disease. 17 million deaths in 2013 were due to CVD.(Roth et al, 2015) Over the years, many studies have shown an increased risk of CVD in a series of chronic inflammatory diseases, where CVD-related mortality increases by approximately 50%. Cardiovascular risk factors (CVRFs), such as metabolic syndrome (MS), obesity, diabetes, chronic renal failure and sleep apnoea syndrome, accelerate arterial ageing and increase the risk of cardiovascular (CV) outcomes. (Castellon et al, 2016; Cuende et al, 2016; Kahlenberg et al, 2013; Manzi et al, 2000)

Methods

Discussion

Conclusion