May 23, 2018

expert reaction to research on severe eczema and cardiovascular problems

A new study, published in the BMJ, investigates whether adults with atopic eczema are at an increased risk of cardiovascular disease and whether the risk varies by atopic eczema severity and condition activity over time.

Dr James Doidge, Senior Research Associate at UCL, said:

“This study is an excellent example of the value of anonymous linked data for research, providing answers that trials and surveys cannot. The findings suggest that eczema and heart disease are closely linked, but the details of how and why are not yet understood. The vast majority of people with mild or moderate eczema can be reassured that the increases in risk observed in these groups were much smaller, in the range of 0-20% after controlling for other risk factors.

“The figures quoted in the press release relate to only the most severe 5% of patients with eczema, and were smaller after controlling for cardiovascular risk factors.  The most likely explanation for the association between eczema and cardiovascular risk is that both are consequences of underlying autoimmune problems that we are only just beginning to understand.”

Prof Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said:

“This high quality study is the largest to date and confirms that people with severe atopic eczema are at slightly increased risk of heart and circulatory diseases including heart failure. Although the reasons for this remain unknown, and the absolute increase in risk is small, GPs should be made aware of the findings and be alert for indicators of cardiovascular risk in their eczema patients.”

Prof Hywel Williams from the British Association of Dermatologists said:

“This is a well conducted and thoughtful study using UK data that confirms previous findings from some other countries. The next step is to understand why there is such an association. It needs to be remembered that most eczema in the UK is very mild or mild in severity and that the increased risks observed in this study only become a potential concern for those with severe disease. It is also unclear what else needs to be done in those with severe eczema that is above and beyond normal good practice for identifying and acting on modifiable cardiovascular risk factors when found.

“However one limitation of the study, which the authors acknowledge, is that the observed association with severe eczema and cardiovascular morbidities could, at least in part, be due to the treatments those with severe eczema receive, such as systemic immunosuppressive therapy.”

* ‘Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study’ by Richard J Silverwood et al. published in The BMJ on Wednesday 23 May 2018.

Declared interests

Dr James Doidge: Nothing to declare.

No others received.