Autoimmune blistering disorders and cardiovascular risks: A population-based cohort study

Kasper Bonnesen; Christian F B Poulsen; Sigrun A J Schmidt; Henrik T Sørensen; Morten Schmidt

doi:10.1016/j.jaad.2024.02.052

Autoimmune blistering disorders and cardiovascular risks: A population-based cohort study

J Am Acad Dermatol. 2024 Mar 15:S0190-9622(24)00486-9. doi: 10.1016/j.jaad.2024.02.052. Online ahead of print.

Authors

Kasper Bonnesen¹, Christian F B Poulsen², Sigrun A J Schmidt³, Henrik T Sørensen⁴, Morten Schmidt⁵

Affiliations

¹ Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: bonnesen@clin.au.dk.
² Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark; Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark.
³ Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
⁴ Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁵ Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Gødstrup Regional Hospital, Herning, Denmark.

PMID: 38492858
DOI: 10.1016/j.jaad.2024.02.052

Abstract

Background: Autoimmune blistering disorders (ABDs) might elevate cardiovascular risk, but studies are lacking.

Objective: The objective of this study was to examine if ABDs elevate the risk of atherosclerotic cardiovascular disease, heart failure, arrhythmia, venous thromboembolism, and cardiovascular death.

Methods: A population-based cohort of Danish patients with ABD (≥18 years of age) diagnosed during 1996-2021 (n = 3322) was compared with an age- and sex-matched comparison cohort from the general population (n = 33,195).

Results: Compared with the general population, patients with ABDs had higher 1-year risks of atherosclerotic cardiovascular disease (3.4% vs 1.6%), heart failure (1.9% vs 0.7%), arrhythmia (3.8% vs 1.3%), venous thromboembolism (1.9% vs 0.3%), and cardiovascular death (3.3% vs 0.9%). The elevated risk persisted after 10 years for all outcomes but arrhythmia. The hazard ratios associating ABDs with the outcomes during the entire follow-up were 1.24 (1.09-1.40) for atherosclerotic cardiovascular disease, 1.48 (1.24-1.77) for heart failure, 1.16 (1.02-1.32) for arrhythmia, 1.87 (1.50-2.34) for venous thromboembolism, and 2.01 (1.76-2.29) for cardiovascular death. The elevated cardiovascular risk was observed for both pemphigus and pemphigoid.

Limitations: Our findings might only generalize to patients with ABDs without prevalent cardiovascular diseases.

Conclusion: Patients with ABDs had an elevated cardiovascular risk compared with age- and sex-matched controls.

Keywords: acute coronary syndrome; angina pectoris; angina, stable; angina, unstable; arrhythmias, cardiac; atrial fibrillation; atrioventricular block; autoimmune diseases; blister; cardiovascular diseases; epidemiology; heart arrest; heart failure; ischemic stroke; myocardial infarction; myocardial revascularization; pemphigoid, bullous; pemphigus; percutaneous coronary intervention; pulmonary embolism; venous thromboembolism; venous thrombosis.