Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies - 04/05/19
, Amy Mulick, MSc b, ∗, Ashley M. Yu, MD c, David Prieto-Merino, PhD b, Morten Schmidt, PhD d, Katrina Abuabara, MD, MA, MSCE e, Liam Smeeth, PhD b, Amanda Roberts, BSc f, Sinéad M. Langan, FRCP, PhD bAbstract |
Background |
Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity.
Objective |
We sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes.
Methods |
MEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes.
Results |
Nineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke.
The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28).
Conclusion |
Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.
Le texte complet de cet article est disponible en PDF.Key words : Atopic eczema, atopic dermatitis, angina, myocardial infarction, heart failure, stroke, ischemic stroke, cardiovascular death, cardiovascular outcomes, risk factors
Abbreviations used : CrI, CVD, GRADE, HR, IRR, OR, PI, PRISMA, PROSPERO, RR
Plan
| PROSPERO registration no. CRD42017060359. |
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| A.A. reports grants from the British Association of Dermatologists during the conduct of the study. K.A. reports grants from the National Institutes of Health, Robert Wood Johnson Foundation, and Dermatology Foundation during the conduct of the study. L.S. reports grants from the Wellcome Trust. S.M.L. reports grants from Wellcome Senior Clinical Fellowship in Science (205039/Z/16/Z) during the conduct of the study (A.M. is also funded on this fellowship). The Wellcome Trust and the British Association of Dermatologists played no role in the development or results of this study, and all authors carried out this research independently of the funding bodies. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funders. |
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| Disclosure of potential conflict of interest: A. Ascott reports grants from the British Association of Dermatologists during the conduct of the study. K. Abuabara reports grants from the National Institutes of Health, Robert Wood Johnson Foundation, and Dermatology Foundation during the conduct of the study. L. Smeeth reports grants from the Wellcome Trust during the conduct of the study; reports grants from the Wellcome Trust, Medical Research Council, National Institute for Health Research, and European Union outside the submitted work; reports personal fees from GlaxoSmithKline for advisory work unrelated to the submitted work; reports grant funding from GlaxoSmithKline for academic research unrelated to the submitted work; acts as an unpaid steering committee chair for AstraZeneca for a randomized trial unrelated to the submitted work; and is a trustee of the British Heart Foundation. S. M. Langan reports grants from Wellcome Senior Clinical fellowship in Science (205039/Z/16/Z) during the conduct of the study (A. Mulick is also funded on this fellowship). The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 143 - N° 5
P. 1821-1829 - mai 2019 Retour au numéro
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