Increased cardiovascular risks and mortality in prurigo nodularis: a global cohort study

Area of Science:

• Cardiology
• Dermatology
• Epidemiology

Background:

• Prurigo nodularis (PN) is a chronic skin condition characterized by intensely itchy nodules.
• While primarily cutaneous, PN has been linked to systemic diseases like diabetes and chronic renal failure.
• Previous studies suggest an association between PN and cardiac/vascular diseases, but with limitations.

Purpose of the Study:

• To investigate the risks of cardiac and vascular diseases and mortality in patients diagnosed with Prurigo nodularis.
• To assess the impact of dupilumab treatment on these risks.

Main Methods:

• Retrospective analysis of electronic health records (EHR) for 64,801 patients with PN and a matched control group.
• Propensity-matching was used to control for confounding factors.
• Sub-analyses examined risks stratified by sex, ethnicity, and treatment modalities.

Main Results:

• PN diagnosis was associated with a significantly higher risk of acute cardiac events, including heart failure and myocardial infarction (HR 1.11).
• All-cause mortality was elevated in PN patients.
• Increased prevalence of chronic vascular diseases (e.g., peripheral arterial disease) and structural heart conditions was observed post-PN diagnosis.
• Risks were more pronounced in white and female patients.
• Dupilumab treatment showed a slight reduction in mortality risk compared to other systemic therapies, but not cardiovascular disease risk.

Conclusions:

• Prurigo nodularis is a significant risk factor for developing a wide spectrum of cardiac and vascular diseases and is associated with increased mortality.
• Healthcare providers should consider these cardiovascular and mortality risks when managing patients with PN.