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. 2018 May 23:361:k1786.
doi: 10.1136/bmj.k1786.

Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study

Richard J Silverwood  1 , Harriet J Forbes  1 , Katrina Abuabara  2 , Anna Ascott  3 , Morten Schmidt  4   5 , Sigrún A J Schmidt  4 , Liam Smeeth  1 , Sinéad M Langan  6
Affiliations

Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study

Richard J Silverwood et al. BMJ. .

Abstract

Objective: To investigate whether adults with atopic eczema are at an increased risk of cardiovascular disease and whether the risk varies by atopic eczema severity and condition activity over time.

Design: Population based matched cohort study.

Setting: UK electronic health records from the Clinical Practice Research Datalink, Hospital Episode Statistics, and data from the Office for National Statistics, 1998-2015.

Participants: Adults with a diagnosis of atopic eczema, matched (on age, sex, general practice, and calendar time) to up to five patients without atopic eczema.

Main outcome measures: Cardiovascular outcomes (myocardial infarction, unstable angina, heart failure, atrial fibrillation, stroke, and cardiovascular death).

Results: 387 439 patients with atopic eczema were matched to 1 528 477 patients without atopic eczema. The median age was 43 at cohort entry and 66% were female. Median follow-up was 5.1 years. Evidence of a 10% to 20% increased hazard for the non-fatal primary outcomes for patients with atopic eczema was found by using Cox regression stratified by matched set. There was a strong dose-response relation with severity of atopic eczema. Patients with severe atopic eczema had a 20% increase in the risk of stroke (hazard ratio 1.22, 99% confidence interval 1.01 to 1.48), 40% to 50% increase in the risk of myocardial infarction, unstable angina, atrial fibrillation, and cardiovascular death, and 70% increase in the risk of heart failure (hazard ratio 1.69, 99% confidence interval 1.38 to 2.06). Patients with the most active atopic eczema (active >50% of follow-up) were also at a greater risk of cardiovascular outcomes. Additional adjustment for cardiovascular risk factors as potential mediators partially attenuated the point estimates, though associations persisted for severe atopic eczema.

Conclusions: Severe and predominantly active atopic eczema are associated with an increased risk of cardiovascular outcomes. Targeting cardiovascular disease prevention strategies among these patients should be considered.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Flowchart for cohort study, 1998-2015
Fig 2
Fig 2
Association between atopic eczema and cardiovascular outcomes, by severity of atopic eczema versus no eczema. *Adjusted for current calendar period (1997-99, 2000-04, 2005-09, 2010-15), time since diagnosis (0-4, 5-9, 10-14, 15-19, ≥20 years), index of multiple deprivation at cohort entry, and time-varying asthma. †Adjusted additionally for body mass index and smoking at cohort entry, and time-varying hyperlipidaemia, hypertension, depression, anxiety, diabetes, and severe alcohol use
Fig 3
Fig 3
Association between atopic eczema and cardiovascular outcomes, by activity of atopic eczema versus no eczema. *Adjusted for current calendar period (1997-99, 2000-04, 2005-09, 2010-15), time since diagnosis (0-4, 5-9, 10-14, 15-19, ≥20 years), index of multiple deprivation at cohort entry, and time-varying asthma. †Adjusted additionally for body mass index and smoking at cohort entry, and time-varying hyperlipidaemia, hypertension, depression, anxiety, diabetes, and severe alcohol use
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