Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort studyBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1786 (Published 23 May 2018) Cite this as: BMJ 2018;361:k1786
- Richard J Silverwood, assistant professor1,
- Harriet J Forbes, research fellow1,
- Katrina Abuabara, assistant professor2,
- Anna Ascott, trainee3,
- Morten Schmidt, registrar45,
- Sigrún A J Schmidt, research fellow4,
- Liam Smeeth, professor1,
- Sinéad M Langan, associate professor1
- 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- 2Program for Clinical Research, Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- 3Royal Sussex County Hospital, Brighton, UK
- 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- 5Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
- Correspondence to: S M Langan
- Accepted 11 April 2018
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.
Contributors: RJS and HJF are joint first authors. RJS, HJF, KA, AA, MS, SAJS, LS, and SML designed the study, contributed to drafts, and approved the final manuscript. RJH, HJF, and SML wrote the first draft. RJH and HJF carried out the statistical analysis. RJH and HJF are the guarantors.
Funding: This work was supported by a Wellcome senior research fellowship in clinical science (205039/Z/16/Z). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funders.
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.
Ethical approval: The study was approved by the Independent Scientific Advisory Committee (16_100RA) and the London School of Hygiene and Tropical Medicine (11961).
Data sharing: No additional data are available.
Transparency: The manuscripts guarantors (RJH and HJF) affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.