Risk of Myocardial Infarction Greater Among Patients With Hidradenitis Suppurativa

Patients with hidradenitis suppurativa (HS) are at significantly greater risk of myocardial infarction (MI), but not cerebrovascular accident (CVA) or peripheral vascular disease (PVD), according to study findings published in Archives of Dermatological Research.

Characterized by its chronic and relapsing disease burden, HS is a skin condition of the hair follicles that is commonly associated with metabolic and cardiovascular comorbidities such as type 2 diabetes, dyslipidemia, obesity, and hypertension.

“Due to the strong association of HS with metabolic syndrome, which is often defined as a combination of glucose dysregulation, hypertension, obesity, and dyslipidemia, the potential of HS being associated with atherothrombotic risk such as MI, stroke, and peripheral arterial disease of the lower extremities, has been explored,” said the study authors.

“Although the association of HS with a higher risk of adverse cardiovascular events has been previously explored, information is still sparse and not well established.”

Seeking to assess the risk and prognostic outcomes of MI, CVA, and PVD in patients with HS, researchers conducted a population-based retrospective cohort study using the computerized database of Clalit Health Services (CHS), the largest managed care organization in Israel.

Participants with HS (n = 6779) were compared with age-, sex-, and ethnicity-matched control subjects (n = 33,260) on the incidence of MI, CVA, and PVD, which was expressed as the number of events per 1000 person-years. The cumulative survival of patients with HS with and without MI, CVA, and PVD diagnosis was also calculated using Kaplan–Meier method and compared via stratifed log-rank test.

To control for putative confounders, outcome measures were adjusted for cardiovascular risk factors, including body mass index (BMI), diabetes mellitus, hyperlipidemia, hypertension, and smoking.

Among the study cohort, mean BMI and the prevalence of smoking, diabetes mellitus, hyperlipidemia, and hypertension were significantly greater in patients with HS than in controls. Overall incidence rates of MI, CVA, and PVD were estimated at 2.9 (2.3-3.4), 1.3 (0.9-1.7), and 0.8 (0.6-1.1) per 1000 person-year, respectively, with corresponding estimates in the control group calculated at 1.8 (1.6-2.0), 1.2 (1.1-1.4), and 0.5 (0.4-0.7) per 1000 person-year, respectively.

After stratifying for all potential confounders, patients with HS were found to be at an increased risk of developing MI (fully-adjusted HR, 1.33; 95% CI, 1.04-1.68; P = .021). Conversely, risk of CVA (fully-adjusted HR, 0.82; 95% CI, 0.59-1.14; P = .245) and PVD (fully-adjusted HR, 1.22; 95% CI, 0.80-1.87; P = .355) was comparable between patients with HS and controls.

Regarding cumulative survival analyses, an increased risk of all-cause mortality was observed among patients with HS and comorbid MI (HR, 12.56; 95% CI, 7.59-20.80; P < .001), CVA (HR, 13.33; 95% CI, 7.29-24.37; P < .001), and PVD (HR, 7.11; 95% CI, 2.61-19.32; P < .001), compared with patients with HS without these comorbidities.

“It is essential for practicing dermatologists to counsel patients with HS regarding this association so patients can best mitigate their own individual cardiovascular and metabolic risk factors, such as ensuring their diabetes is well controlled, attempting smoking cessation, and emphasizing healthy lifestyle modifcations,” wrote the researchers.

They concluded that further research is warranted to investigate these significant associations and their underlying pathogenic mechanisms.

Reference

Kridin K, Valido K, Cohen JM, Cohen AD. Hidradenitis suppurativa and the risk of myocardial infarction, cerebrovascular accident, and peripheral vascular disease: a population‑based study. Arch Dermatol Res. Published online July 23, 2022. doi:10.1007/s00403-022-02369-5