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The cardiovascular risk in bullous pemphigoid: Insights from a population-based study
Khalaf Kridin1,2,3, Rina Goychberg2, Mouhammad Kridin4
1Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel.
Insights
Patients with bullous pemphigoid (BP) face increased risks of major cardiovascular events, including myocardial infarction (MI) and stroke. Cardiovascular prevention strategies are crucial for managing these patients.
Area of Science:
- Cardiovascular epidemiology
- Dermatology
- Public health
Background:
- The cardiovascular risk in bullous pemphigoid (BP) patients is not consistently reported.
- Major adverse cardiovascular outcomes pose a significant threat to patients with BP.
Purpose of the Study:
- To assess the risk of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD), and pulmonary embolism (PE) in BP patients.
- To investigate the impact of different BP treatments on these cardiovascular risks.
Main Methods:
- A population-based retrospective cohort study comparing 3924 BP patients with 19,280 matched controls.
- Multivariate Cox regression analysis was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI).
- Data were sourced from Clalit Health Services' computerized database.
Main Results:
- BP patients showed significantly elevated risks for MI (HR: 1.44), CVA (HR: 1.24), PVD (HR: 1.60), and PE (HR: 1.72) compared to controls.
- BP patients with comorbid MI, CVA, PVD, or PE had a heightened risk of all-cause mortality.
- Therapeutic approaches for BP did not significantly alter the risk of cardiovascular outcomes.
Conclusions:
- Bullous pemphigoid is linked to increased risks of MI, CVA, PVD, PE, and cardiovascular mortality.
- Implementing comprehensive cardiovascular prevention measures is recommended for all BP patients.
Background:
The risk of life-threatening major cardiovascular outcomes among patients with bullous pemphigoid (BP) is inconsistent in the current literature.
Objective:
To evaluate the risk and prognostic outcomes of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD) and pulmonary embolism (PE) in patients with BP. We additionally aimed to explore the influence of different therapeutic approaches on the risk of these outcomes.
Methods:
A population-based retrospective cohort study was conducted to compare BP patients (n = 3924) with age-, gender- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of MI, CVA, PVD and PE. Adjusted hazard ratio (HR) and 95% confidence intervals (CI) were estimated by multivariate Cox regression analysis. Data were retrieved from Clalit Health Services' computerized database.
Results:
Relative to their matched controls, patients with BP were at an elevated risk of MI (fully-adjusted HR: 1.44; 95% CI: 1.14-1.81; p = 0.002), CVA (fully-adjusted HR: 1.24; 95% CI: 1.06-1.45; p = 0.007), PVD (fully-adjusted HR: 1.60; 95% CI: 1.27-2.03; p = 0.003) and PE (fully-adjusted HR: 1.72; 95% CI: 1.28-2.32; p < 0.008). Patients with BP experienced heightened risk of all-cause mortality in the presence of comorbid MI (fully-adjusted HR: 1.61; 95% CI: 1.44-1.81; p < 0.001), CVA (fully-adjusted HR: 1.70; 95% CI: 1.52-1.89; p < 0.001), PVD (fully-adjusted HR: 1.38; 95% CI: 1.20-1.58; p < 0.001) and PE (fully-adjusted HR: 1.44; 95% CI: 1.10-1.88; p = 0.007). The therapeutic approach utilized to manage BP did not significantly influence the risk of cardiovascular outcomes.
Conclusions:
BP is associated with an elevated risk of MI, CVA, PVD, PE and cardiovascular mortality. Primary, secondary and tertiary cardiovascular prevention measures should be implemented among patients with BP.
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