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Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

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  • Anna Ascott, Royal Sussex County Hospital
  • ,
  • Amy Mulick, London School of Hygiene and Tropical Medicine
  • ,
  • Ashley M. Yu, t of Biology, University of Ottawa, 30-268 Marie Curie, Ottawa, Ontario K1N 6N5, Canada
  • ,
  • David Prieto-Merino, London School of Hygiene and Tropical Medicine
  • ,
  • Morten Schmidt
  • Katrina Abuabara, University of California San Francisco
  • ,
  • Liam Smeeth, London School of Hygiene and Tropical Medicine
  • ,
  • Amanda Roberts, Nottingham Support Group for Carers of Children with Eczema
  • ,
  • Sinéad M. Langan, London School of Hygiene and Tropical Medicine

Background: Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity. Objective: We sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes. Methods: MEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes. Results: Nineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28). Conclusion: Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Pages (from-to)1821-1829
Number of pages9
Publication statusPublished - May 2019

    Research areas

  • angina, atopic dermatitis, Atopic eczema, cardiovascular death, cardiovascular outcomes, heart failure, ischemic stroke, myocardial infarction, risk factors, stroke

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