Acne Inversa Linked to Cardiovascular Disease

Fran Lowry

March 05, 2019

Acne inversa is associated with an elevated risk for stroke, coronary artery disease, heart failure, and peripheral artery disease, according to a new study.

Rachael Ward

"And this risk persists even after we control for comorbidities such as hyperlipidemia, smoking, and diabetes," said lead investigator Rachael Ward, MPH, from Duke University School of Medicine in Durham, North Carolina.

"When these patients present to dermatologists or to primary care physicians or even pediatricians — because acne inversa can occur in kids — we should be screening them much more vigilantly so that we can identify cardiovascular disease risk factors," she told Medscape Medical News.

"If they have diabetes, we need to start them on treatment right away. If they have hyperlipidemia, refer them to get started on appropriate treatment or refer them to a healthy lifestyle clinic where they can learn about healthy diet and exercise," Ward said.

Tarannum Jaleel

"These patients have a higher comorbidity burden than the general dermatology patients we see on a regular basis," said senior study investigator Tarannum Jaleel, MD, also from Duke, who presented the findings at the American Academy of Dermatology 2019 Annual Meeting in Washington, DC.

"Many do not have a primary care physician. I was treating a lot of patients aged 17, 18, who had BMIs close to 40 kg/m². They were presenting with dyslipidemia at a much younger age than you would expect," she reported.

Jaleel explained that she now screens these patients, "even though they may be young, because they get their heart attacks much younger than people who don't have acne inversa."

Ward was prompted to examine the link between this skin condition and cardiovascular disease because many of her family members who had acne inversa died early from heart disease. After a literature search failed to provide conclusive evidence of a link, she and her colleagues decided to conduct their own population-based analysis.

The team performed a retrospective cohort study of 4914 patients at Duke University Medical Center with an ICD code for hidradenitis suppurativa, 4641 patients with an ICD code for psoriasis, and a random selection of 23,266 healthy control subjects.

After adjustment for a number of variables — including sex, age, race, hypertension, hyperlipidemia, diabetes, smoking, and body mass index — patients with acne inversa were at higher risk than control subjects for stroke (P = .0065), peripheral artery disease (P = .0002), coronary artery disease (P = .0064), and heart failure (P = .3484).

They were also at higher risk for these events than patients with psoriasis, although not significantly so.

"I would like to see patients with this condition evaluated more comprehensively for their additional comorbidity risk factors and to have their inflammation treated aggressively earlier on instead of letting it progress," Jaleel said.

"As a dermatologist in a specialty clinic, I see patients at a much later stage of disease," she pointed out. By the time acne inversa patients are referred to a specialist, there can be a delay in diagnosis of 7 or 8 years.

I am beginning to think that every inflammatory disease may be related to cardiovascular disease.

The first thing a dermatologist should do is ask whether the patient has a primary care physician; because these are younger patients, they might not, said Jaleel.

The next thing to do is screen these patients for cardiovascular disease risk factors and refer them for appropriate treatment.

"I am beginning to think that every inflammatory disease may be related to cardiovascular disease," said Robert Brodell, MD, from the University of Mississippi Medical Center in Jackson.

"It started with gingivitis and bad dentition associated with heart disease. Then psoriasis and the metabolic syndrome, including cardiovascular disease, and more recently, eczema," he told Medscape Medical News.

Ward and Brodell have disclosed no relevant financial relationships. Jaleel reports financial relationships with Lilly Pharmaceuticals and Canfield Scientific.

American Academy of Dermatology (AAD) 2019 Annual Meeting. Presented March 3, 2019.

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