Decreased Risk of Aneurysms in Marfan Syndrome Patients With Atopic Dermatitis

Abstract

Increased transforming growth factor-beta (TGF-β) signaling is noted in aortic aneurysm formation, with depressed TGF-β levels found in atopic dermatitis (eczema). This research addressed whether eczema is associated with fewer aneurysms and aortic repairs in patients with Marfan syndrome (MS) owing to theoretically lower levels of TGF-β activity. A retrospective cohort study was conducted using the global health research network TriNetX. Patients with MS were identified using diagnosis codes, and the data extracted included demographics, diagnoses, and procedures. Case-control cohorts were developed using a coarsened exact-matching algorithm based on age, hypertension, smoking status, obesity, diabetes, coronary artery disease, chronic kidney disease, and chronic obstructive pulmonary disease to mitigate confounding variables. Among the 15,964 patients who met the inclusion criteria, 244 (1.5%) had had eczema, 3178 (19.9%) had had an aortic aneurysm or dissection at a median age of 37 years (interquartile range, 24-53 years), and 394 (2.5%) had undergone ascending aortic repairs at a median age of 36 years (interquartile range, 26-50 years). On univariate analysis, a negative correlation was found between the diagnosis of eczema and the diagnosis of an aortic aneurysm or dissection (P = .003), with a trend toward a negative correlation between the diagnosis of eczema and the requirement for ascending aortic repair (P =.15; Table). Patients with and without eczema had had a similar ages at aortic aneurysm or dissection diagnosis (P = .19) and at aortic repair (P = .65). After matching, 13,042 patients without eczema and 239 patients with eczema were included in the multivariate analysis. Patients with eczema had a decreased risk of aneurysm or aortic dissection (odds ratio, 0.93; 95% confidence interval, 0.89-0.97; P = .003) and a lower likelihood of requiring ascending aortic repair (odds ratio, 0.98; 95% confidence interval, 0.95-1.0; P = .009) compared with patients without eczema. The presence of eczema might convey a modest protective effect against aortic events and a reduced risk of ascending aortic repair in patients with MS. This association can be explained by the putative role of TGF-β in the pathogenesis of eczema and aneurysm formation and calls for further research into other disease states driven by TGF-β.TableComorbidities of Marfan syndrome (MS) patients stratified by eczemaComorbidityEczema, % (No.)P valueYesNoHypertension24.7 (60)20.9 (3279).14Smoking10.3 (25)9.1 (1437).63Obesity16.9 (41)6.8 (1068)1.99 × 10−9Diabetes mellitus7.8 (19)4.4 (686).02Coronary artery disease4.5 (11)5.5 (859).58Chronic kidney disease2.1 (5)3.5 (549).28Chronic obstructive pulmonary disease4.5 (11)4.2 (654).67Aortic aneurysm or dissection11.5 (28)19.3 (3035).003Ascending aortic repair0.81 (2)2.5 (389).15 Open table in a new tab