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Deciphering the Connection Between Atopic Dermatitis and Cardiovascular Diseases: Analysis of Clinical Associations
Danielle Fehr1,2,3, Van Hung Huynh-Tran3, Laura Maintz3,4
1Allergy Unit, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
Insights
Atopic dermatitis (AD) is not overall linked to cardiovascular disease (CVD). However, severe AD without other allergies may increase CVD risk, with CCL18 potentially serving as a biomarker.
Area of Science:
- Dermatology
- Cardiology
- Immunology
Background:
- Conflicting data exists on the association between atopic dermatitis (AD) and cardiovascular diseases (CVD).
- Investigating potential biomarkers for CVD risk in AD patients is crucial.
Purpose of the Study:
- To explore the association between AD and CVD.
- To identify potential biomarkers for CVD risk in AD patients.
Main Methods:
- A multicenter case-control study (ProRaD) included 677 AD patients and 79 controls.
- Assessed AD severity, atopic/metabolic/cardiovascular conditions, and risk factors.
- Analyzed serum samples using targeted proteomics (Olink cardiometabolics panel).
Main Results:
- No overall association found between AD and CVD.
- Pure AD patients had higher CVD prevalence than those with atopic comorbidities, but this was not confirmed when controlling for risk factors.
- In pure AD, higher Eczema Area and Severity Index (EASI) scores predicted CVD risk. Forty cardiometabolic proteins were upregulated in AD patients, with CCL18 elevated in both AD and CVD, correlating with AD severity.
Conclusions:
- No overall association between AD and CVD, suggesting a complex relationship.
- Disease severity may be a CVD risk factor in pure AD patients.
- CCL18 shows potential as a CVD biomarker.
Background:
There are conflicting data on a potential association between atopic dermatitis (AD) and cardiovascular diseases (CVD). The aim of this study was to further explore this connection and whether there are biomarkers indicating the risk for CVD in AD patients.
Methods:
We included 677 AD patients and 79 nonatopic controls from an observational multicenter case-control study (ProRaD: Prospective longitudinal study investigating the remission phase in patients with atopic dermatitis and other allergy-associated diseases). AD severity and atopic, metabolic, and cardiovascular conditions as well as risk factors were assessed. Serum samples were analyzed with targeted proteomics (cardiometabolics panel, Olink).
Results:
We did not find an overall association between AD and CVD. However, AD patients without atopic comorbidities (pure AD) showed a significantly higher CVD prevalence than AD patients with atopic comorbidities (ADAC) (28.2% [37/131] vs. 14.7% [80/546], p < 0.001). Yet, this association could not be confirmed when controlling for cardiovascular risk factors. In pure AD, patients with CVD showed a more severe AD than those without CVD (median EASI [Eczema Area and Severity Index] 12.9 vs. 4.0, p < 0.001). In this subgroup of patients, EASI remained a significant predictor of CVD even in the adjusted model (adjusted odds ratio [aOR] = 1.05, p = 0.040). Forty serum cardiometabolic proteins were upregulated in AD patients compared with nonatopic controls. CC-chemokine ligand 18 (CCL18) was upregulated in both AD (p < 0.001) and CVD (p < 0.001) and its increase correlated with AD severity.
Conclusions:
Our study does not suggest an overall association between AD and CVD, but a more complex relation between the two conditions. Disease severity may be a risk factor for CVD in pure AD patients, but not in those with atopic comorbidities. CCL18 may be a biomarker for CVD.
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