Cross-Sectional Study of Psoriasis, Atopic Dermatitis, Rosacea, and Alopecia Areata Suggests Association With Cardiovascular Diseases

June 2023 | Volume 22 | Issue 6 | 576 | Copyright © June 2023


Published online May 16, 2023

doi:10.36849/JDD.7424

Angel D. Pagan BSa,b*, Seungyeon Jung BSa,c*, Stella Caldas BSa,d, Jonathan Ungar MDa, Nicholas Gulati MD PhDa, Benjamin Ungar MDa

aDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
bPonce Health Sciences University School of Medicine, Ponce, PR
cVanderbilt University School of Medicine, Nashville, TN
dGeorge Washington University School of Medicine, Washington, DC

*Contributed equally

Abstract
Background: A growing body of evidence suggests that several inflammatory skin diseases (ISDs) are associated with systemic inflammation and cardiovascular disease (CVDs).
Methods: We used the TriNetX analytics platform to conduct a retrospective, cross-sectional, single-center study in the Mount Sinai Health System network. Cases (all patients ≥18 years of age with a diagnosis of 1 of the 4 ISDs studied) were compared with matched controls (no history of any of these ISDs) to evaluate odds ratios for being diagnosed with CVD.
Results: We identified a total of 70,090 patients with ISDs, including 35,160 patients with atopic dermatitis, 19,490 with psoriasis, 12,470 with rosacea, and 2,970 with alopecia areata, and 70,090 propensity score-matched controls without any of these ISDs. Patients with atopic dermatitis and psoriasis had significantly increased odds of all CVD diagnoses analyzed compared to controls (P<0.001 for all comparisons). Patients with rosacea had significantly increased odds of being diagnosed with all diseases of the circulatory system (P<0.001), hypertensive diseases (P<0.001), cerebrovascular diseases (P=0.037), and arterial disease (P<0.001) compared to controls. Patients with alopecia areata had increased odds for all diseases of the circulatory system (P<0.001), hypertensive diseases (P<0.001), and arterial disease (P<0.001). The prevalence of patients with elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels was significantly greater in all ISD groups compared to controls.
Conclusion: This study identified significant associations between ISDs and several CVD diagnoses. Furthermore, CRP and ESR were elevated in all ISD groups compared to controls.


Pagan AD, Jung S, Caldas S, et al. Cross-sectional study of psoriasis, atopic dermatitis, rosacea, and alopecia areata suggests association with cardiovascular diseases. J Drugs Dermatol. 2023;22(6):576-581. doi:10.36849/JDD.7424

INTRODUCTION

Inflammatory skin diseases (ISDs), including atopic dermatitis (AD), psoriasis, rosacea, and alopecia areata (AA), contribute to a significant global burden of disease and are associated with profound negative effects on patients' quality of life.1-5 Patients often suffer from increased rates of depression and anxiety, as well as the negative financial impact, especially in those suffering from severe symptoms and recalcitrant disease.1-4

Although each of these ISDs involves a complex pathogenesis, they all share central features of immune activation, increasingly recognized as being systemic in many cases.6-14 The systemic inflammation associated with dysregulated immune responses, in turn, has been proposed as a possible contributor to diseases such as hypertension and atherosclerosis.15,16 Although a growing body of evidence has linked psoriasis with cardiovascular risk factors including smoking, obesity, and hypertension, it has also been identified as a possible independent risk factor for cardiovascular disease (CVD).17-19 More recently, emerging evidence demonstrates an association between AD and increased CVD including stroke, myocardial infarction, and heart failure.6,7,20 Additionally, a study using 18F-fluorodeoxyglucose-positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) demonstrated greater vascular inflammation in AD patients compared with controls.21
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