From the Journals

Atopic eczema linked to cardiovascular disease risk

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Eczema: Another inflammatory condition linked to CVD

The evidence in favor of a link between chronic inflammatory conditions, such as rheumatoid arthritis, and cardiovascular disease is growing. However, there are conflicting data and some of the uncertainty may be a result of a dose-response effect, where the increased cardiovascular risk is seen only in people with more severe disease.

This study and its finding of increased cardiovascular risk in patients with severe or more active eczema supports the case for targeted screening of this group for standard cardiovascular disease risk factors. It also could prompt incorporation of severe eczema as an independent cardiovascular disease risk factor in calculation of thresholds for primary prevention interventions.

The findings also may have implications for health care resources allocated to treatment of eczema, as prevention of cardiovascular disease could contribute to the argument in favor of the more expensive next-generation biologic treatments for eczema that are becoming available.

John R. Ingram, MD, is senior lecturer and consultant dermatologist, dermatology and academic wound healing in the division of infection and immunity at Cardiff (U.K.) University. These comments are taken from an accompanying editorial No conflicts of interest were declared. (BMJ. 2018 May 23. doi: 10.1136/bmj.k2064).


 

FROM THE BMJ


“Mechanistic work suggests that atopic eczema may be associated with increased platelet activation and decreased fibrinolysis, which may increase the risk of clotting, though a recent study found no association with metabolite levels,” the authors wrote.

They noted that the strengths of their study were that it was largest to examine the association between atopic eczema and cardiovascular risk, and that they had access to data on body mass index, smoking, and severe alcohol use for most of the study population, which enabled them to adjust for these potential mediators.

“Consideration should be given to developing prevention strategies to reduce the risk of cardiovascular disease among patients with severe or predominantly active atopic eczema, including awareness of and screening for conventional cardiovascular risk factors by those providing clinical care,” they wrote.

The study was supported by the Wellcome Trust, and no relevant conflicts of interest were declared.

SOURCE: Silverwood R et al. BMJ 2018 May 23;361:k1786. doi: 10.1136/bmj.k1786.

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