Hidradenitis Suppurativa Tied to Higher MI Risk
NEW YORK (Reuters Health) – Patients with hidradenitis suppurativa (HS) appear to be at increased risk of cardiovascular events, including myocardial infarction, according to a new study.
The risk of cardiovascular events in patients with this chronic inflammatory skin disease has not been well established, Dr. Amit Garg of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, in New Hyde Park, New York, and colleagues note in JAMA Dermatology, online November 13.
To help do so, the researchers examined a U.S. database involving more than 56 million patients and identified nearly 50,000 who had HS. Three-quarters were women, and the mean age was 38.3 years. More than 1.4 million patients without HS served as controls.
Although the crude incidence of MI and cerebrovascular accident (CVA) or their composite was actually higher in controls than in the patients, this was no longer the case after adjustment for a variety of factors including hypertension, hyperlipidemia and type 2 diabetes.
In adjusted analysis, patients with HS had significant increases in the risk of composite disease (hazard ratio, 1.23) and of MI alone (HR, 1.21) and CVA alone (HR, 1.22).
However, the strength of association between HS and composite MI or CVA declined in increasing age groups. The highest relative difference between composite MI or CVA risk in patients versus controls was seen in those aged 18 to 29 years (HR, 1.67).
Because of low numbers, the researchers did not compare TNF-inhibitor-exposed patients with TNF-inhibitor-exposed controls. However there was no significant difference in risk of composite disease and individual outcomes in patients taking adalimumab or infliximab at any point and those who did not.
In addition the researchers point out that they “could not reliably ascertain use of aspirin as a risk-mitigating strategy because this medication is available without prescription.”
Given the apparently increased risk in HS patients, the researchers conclude that, “Periodic assessment of cardiovascular risk with early management of modifiable risk factors, including smoking, obesity, diabetes, dyslipidemia, and hypertension, may be warranted.”
Dermatologist Dr. Hailey Naik of the UCSF Hidradenitis Suppurativa Clinic, in San Franciso, told Reuters Health by email, “What is not clear from this study is whether the relationship between HS and heart attacks or strokes is a biological one, or if other factors, like access to timely care or socioeconomic status, contribute to this relationship.”
“Regardless,” concluded Dr. Naik, who was not involved in the study, “these data do underscore the need for urgent advancement of our understanding of HS biology, effective treatments, and barriers to optimal care. People living with HS should discuss strategies to reduce known cardiovascular risks with their doctors, including control of blood sugar, blood pressure and cholesterol, as well as tobacco cessation.”
Dr. Garg did not respond to requests for comments.
JAMA Dermatol 2019.