Key clinical point: Patients with hidradenitis suppurativa (HS) should be informed of their increased risk of major adverse cardiac events.

Major finding: HS was associated with an increased risk of cerebrovascular accident in the pooled analysis of cohort studies (risk ratio, 1.22; 95% confidence interval [CI], 1.14-1.31), and increased odds of CVA in the pooled analysis of case-control studies (odds ratio, 1.72; 95% CI, 1.38–2.13). HS was also associated with an increased risk of myocardial infarction (P less than .001) in the pooled analysis of cohort studies.

Study details: The data come from a systematic review and meta-analysis of 4 cohort and 4 case-control studies.

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Commentary

“This systematic review and meta-analysis found that hidradenitis suppurativa (HS) is associated with an increased risk of cerebrovascular accident (CVA) and myocardial infarction (MI), helping to answer more definitively the connection between HS and major adverse cardiac events.

HS is now generally accepted to be associated with increased cardiovascular risk. HS is a chronic inflammatory state in which circulating proinflammatory cytokines may drive endothelial dysfunction and atherosclerosis. HS is also independently associated with several cardiovascular risk factors, including smoking, obesity, diabetes mellitus, and dyslipidemia. Prior studies suggest HS patients are more likely to have atherosclerotic disease than controls, more likely to experience major cardiovascular events, and at greater risk of cardiovascular death.

While it is not known whether effective HS management reduces the risk of major adverse cardiac events, contact with healthcare providers offers an opportunity for screening and addressing modifiable cardiovascular risk factors among such patients.”

Robert G. Micheletti, MD

Assistant Professor of Dermatology and Medicine

Perelman School of Medicine, University of Pennsylvania

References:

Riis PT, Søeby K, Saunte DM, Jemec GB. Patients with hidradenitis suppurativa carry a higher systemic inflammatory load than other dermatological patients. Archives of dermatological research. Dec 2015;307(10):885-9. doi:10.1007/s00403-015-1596-5

Egeberg A, Gislason GH, Hansen PR. Risk of Major Adverse Cardiovascular Events and All-Cause Mortality in Patients With Hidradenitis Suppurativa. JAMA dermatology. Apr 2016;152(4):429-34. doi:10.1001/jamadermatol.2015.6264

González-López MA, Hernández JL, Lacalle M, et al. Increased prevalence of subclinical atherosclerosis in patients with hidradenitis suppurativa (HS). J Am Acad Dermatol. Aug 2016;75(2):329-35. doi:10.1016/j.jaad.2016.03.025