Cardiovascular and Cardiometabolic Risk in HS Demands Greater Clinical Attention, With Raj Chovatiya, MD, PhD

Patients with hidradenitis suppurativa (HS) face a broad spectrum of cardiovascular and cardiometabolic comorbidities, with risk elevations for multiple major outcomes that are consistent across study designs and geographic regions, according to a recent review and meta-analysis presented at the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 held in Denver, Colorado, from March 27-31.

caught up with investigator Raj Chovatiya, MD, PhD, clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology + Immunology Research in Chicago, Illinois, during the meeting, who argued that these findings should push dermatologists toward more systematic cardiovascular risk assessment in patients with HS.

The study was a PRISMA-guided systematic review and random-effects meta-analysis of studies identified through a search of PubMed, Embase, Scopus, CINAHL, and the Cochrane Library from inception through June 16, 2025. Twenty-five studies encompassing 373,689 patients with clinician-diagnosed HS were included. Random-effects meta-analyses were performed using the DerSimonian-Laird estimator, with between-study heterogeneity quantified using Cochran's Q, τ², and I².

Pooled prevalence estimates revealed a broad comorbidity profile across the included populations. Hypertension was the most prevalent condition, affecting 25.52% (95% CI, 20.88-30.45) of patients. Other pooled prevalence estimates included coronary artery disease at 4.2% (95% CI, 1.8-7.4), congestive heart failure at 1.9% (95% CI, 1.2-2.7), myocardial infarction at 1.9% (95% CI, 1.2-2.7), atrial fibrillation or flutter at 1.7% (95% CI, 1.0-2.6), cerebrovascular disease at 2.2% (95% CI, 1.2-3.3), and peripheral vascular disease at 2.2% (95% CI, 0.9-3.9).

The risk association analyses yielded findings Chovatiya described as the most clinically consequential output of the meta-analysis. HS was associated with a risk ratio (RR) of 1.85 (95% CI, 1.44-2.38) for heart failure, 1.75 (95% CI, 1.59-1.92) for coronary and ischemic heart disease, and 1.51 (95% CI, 1.22-1.88) for myocardial infarction. Risk of venous thromboembolism was also elevated, with an RR of 1.72 (95% CI, 1.45-2.05), as was all-cause mortality, with an RR of 1.86 (95% CI, 1.10-3.12). HS was additionally associated with a 52% increased odds of hypertension versus comparators (odds ratio, 1.52; 95% CI, 1.29-1.80). These associations were consistent across study designs and geographic regions. Chovatiya noted that while some pooled prevalence estimates were numerically similar to general population ranges, HS cohorts were disproportionately younger and female — populations in which this degree of cardiovascular risk is not typically expected — suggesting the clinical significance of these findings exceeds what raw prevalence numbers alone convey.

Chovatiya characterized the breadth of the comorbidity profile as the finding that most surprised him on reflection, noting that the aggregated published literature paints a picture of risk that extends across virtually every major cardiovascular outcome category. He framed the findings as supporting a shift toward routine cardiometabolic risk assessment and multidisciplinary preventive care in HS, while acknowledging that the most pressing unanswered question — whether timely targeted therapy modifies these outcomes — cannot be addressed by the existing retrospective observational evidence base. Most included studies lacked detailed reporting on HS severity, treatment exposure, and longitudinal risk factor trajectories, precluding causal inference. Prospective cohort studies and registry-based approaches capturing patients at or near disease onset will be needed to establish whether early intervention changes the cardiovascular trajectory in this population.

“I think what's really probably missing is, in addition to what I talked about [with] good prospective epidemiology, is trying to connect therapeutic intervention to some of these functional outcomes to see, indeed, if these are real risk factors, does timely intervention with targeted treatments make a difference,” Chovatiya said.

Chovatiya previously reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc., Regeneron, RAPT, Sanofi, Sitryx, and UCB.

Mense SA, Hopkins T, Chovatiya R. Prevalence and risk of cardiovascular comorbidities and cardiometabolic factors in hidradenitis suppurativa: a systematic review and meta-analysis. Poster #76428. Presented at: AAD Annual Meeting; Denver, Colorado; March 27-31, 2026.

Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. 

. 2016;152(4):429-434. doi:10.1001/jamadermatol.2015.6264

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HS is associated with up to a nearly 2-fold increased risk of heart failure, coronary artery disease, myocardial infarction, venous thromboembolism, and all-cause mortality.

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Carlos Bacino, MD, is the medical director of the cytogenetics laboratory at Baylor Genetics.

Once-Weekly Navepegritide Safe and Efficacious for Achondroplasia, With Carlos Bacino, MD

 approved Ascendis Pharma’s navepegritide treatment for 

 met with Carlos Bacino, MD, medical director of the Cytogenetics Laboratory at Baylor Genetics and a lead author on the pivotal ApproaCH study, which drove the FDA’s approval under the Accelerated Approval Program. Bacino discussed the reassuring safety data coming from the trial program.

“This is a drug that has been shown to be very safe in that the side effects have been mild and not clinically significant,” Bacino told 

. “These drugs do have an effect on blood pressure, potentially decreasing it – in this particular situation, this is something that has been looked at very carefully to determine if it has caused any clinical hypotension and decreasing blood pressure. In most cases, these side effects are minimal.”

Navepegritide is a prodrug of C-type natriuretic peptide (CNP) utilizing the TransCon technology platform, which is designed to transiently link an inert carrier to a parent drug with known biology. The moiety of CNP in navepegritide is identical to the amino acid sequence 89-126 of endogenous CNP – after weekly subcutaneous administration, autocleavage of the linker occurs under physiologic pH and temperature. This provides predictable, sustained release and continuous systemic exposure to active CNP.

The FDA’s decision was based on the pivotal ApproaCH phase 2b randomized, double-blind, placebo-controlled, multicenter trial, conducted across 10 academic hospitals across 7 countries. Patients aged 2-11 years with a genetically confirmed achondroplasia diagnosis who were naïve to treatment with growth-promoting agents and height recorded ≥6 months prior to randomization were eligible for inclusion. Patients with radiographic evidence of closed growth plates, severe untreated sleep apnea, or conditions known to affect growth, among other criteria, were excluded.

Patients were randomly assigned in a 2:1 ratio to receive either subcutaneous navepegritide at 100 µg/kg/week or placebo; both drugs were administered once weekly for 52 weeks, followed by 52 weeks of follow-up. A total of 86 patients were screened and 84 were enrolled, with 57 randomized to navepegritide and 27 to placebo. Navepegritide demonstrated superiority to placebo at week 52, as children receiving it achieved a least-squares mean AGV of 5.89 versus 4.42 cm/year for those treated with placebo.

Bacino also discussed the promising potential of weekly injections as opposed to daily treatment. He mentions the likelihood of increased adherence and more direct drug effects via the TransCon platform.

“The weekly injection will allow a much more physiologic delivery of the drug and will definitely improve adherence, as it is certainly better for children, who are often reluctant to needles,” Bacino said. “It’s also better for parents who are not necessarily happy about the frequency of injections, and it’s better for the busy family to be able to handle the drug regimen.”

Editors’ Note: Bacino reports disclosures with Ascendis Pharma, BioMarin Pharmaceutical, IONIS Pharmaceuticals, and Teladoc Health.

Ascendis Pharma. FDA Approves Once-Weekly YUVIWEL (navepegritide) for Children with Achrondroplasia Aged 2 Years and Older. February 27, 2026. Accessed April 15, 2026. 

https://investors.ascendispharma.com/news-releases/news-release-details/fda-approves-once-weekly-yuviwelr-navepegritide-children

Savarirayan R, McDonnell C, Bacino CA, et al. Once-weekly Navepegritide in children with achondroplasia. JAMA Pediatrics. 2026;180(1):18. 

Bacino highlights the recently approved treatment’s safety data and emphasizes the likelihood of increased adherence due to longer intervals between administration.

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Hormonal Disorders

Richard Miller, MD, staff psychiatrist at Elwyn Adult Behavioral Health in Cranston, Rhode Island.

Patients are increasingly bringing AI-generated 

 advice into clinical encounters, raising new challenges for psychiatrists caring for individuals with severe mental illness. In this Q&A, Richard Miller, MD, staff psychiatrist at Elwyn Adult Behavioral Health in Cranston, Rhode Island, discusses how tools such as ChatGPT are shaping conversations in outpatient psychiatry.

 present AI-derived recommendations, sometimes with limited context or accuracy. He explains how clinicians can validate patient curiosity while clarifying misinformation, protect the therapeutic alliance, and assess when AI use may reinforce maladaptive thinking. Miller also outlines potential roles for AI in documentation and education, emphasizing the need to maintain comprehensive, clinician-guided care.

Watch the dynamic feature on using AI as your therapist or psychiatrist, featuring Miller, 

 In your practice, are you already seeing patients use tools like ChatGPT for mental health advice, and what does that look like in real clinical encounters?

 I've seen it a lot, and it's not always good, and there needs to be some asterisks next to the information that they attain in the context.

Just for reference, I do outpatient psychiatry…serving the most sick folks in the community, [with] severe, persistent mental illness. A lot of patients [with] schizophrenia, bipolar disorder. I say that because those are the folks that are primarily coming to me with…statements [such as], “Hey, I plugged this into ChatGPT” or “I looked this up on AI, and this is what I've been told I need to talk to you about.”

These are individuals that at their baseline struggle with paranoia, sometimes with human validation…and they're putting stuff into an algorithm and getting an answer and maybe having a preconceived notion of what they want the answer to be. They're just coming to me with information which [are] not always accurate, largely inaccurate at times, and it's thrown together.

 How are patients interpreting the guidance that they get? Are they treating it as supplemental or as a substitute for clinical care?

 It's kind of both. There's some folks that I would say that are [a] bit higher functioning that might come to me and say, “Hey, I was looking this up because I know we've chatted about this, and this is what the ChatGPT has told me.” It might be based on a discussion we've had earlier…and it might supplement. Maybe it's something that is brand new and quite useful to both of us.

More often, it's actually deleterious where information is kind of cherry-picked, and the context is not always understood. Patients are kind of going on an extended trip and excursion to get the information that they're looking for…maybe [a] particular answer. I would say the higher the degree of functionality, in large part, I find it to be more deleterious than useful.

 When a patient brings in an AI-generated device, how do you approach that conversation without undermining the trust or therapeutic alliance?

 I always ask them where they're coming from and how they got the information. I always validate them and say, “Hey, thanks for bringing this to my attention. Thank you for sharing this with me. However, let's talk, or let's see what the entirety of the picture is.”

 Do you think clinicians should be proactively asking about AI use as a part of a routine history taking?

 Proactively, I'm not sure, but it should be part [of] the background to make sure they understand that a lot of people are looking into this. That's not something that has to be [at] the forefront of the discussion, but something that needs to be kept on the burner.

What concerns you most about patients with mental illness using AI as a therapist or psychiatrist?

 There's a reason I went to medical school…we need to put together the entire clinical picture.

My biggest concern is that patients are getting information piecemeal and [poorly] putting together to create a recipe or a puzzle… Pieces are not appropriate. They're not getting the entire clinical picture.

 Are there specific red flags that suggest AI use is becoming clinically problematic or reinforcing maladaptive thinking?

 It really depends. I don't want you to think I'm in a clinic where people are coming in every session with AI information. It comes up [about] 3 times a week.

It's caught me off guard sometimes; sometimes people you wouldn't expect [use AI]. It's becoming more prominent. It's kind of forcing us, in a good way, to stand our toes, to make sure that we are aware that these technologies are out there, and sometimes they are sources of misinformation.

 Where do you see the most practical appropriate role for AI in psychiatric care, whether in documentation screening or decision support?

 There is a lot of AI-generated software that's helping with documentation. I don't use it, not because I am against it, because we don't support it in my…place of employment.

It’s good to encourage patients to think more and learn more about their illness, but [it] really depends on the patient. Somebody who's paranoid…is going to maybe be more susceptible to misinformation… whereas somebody who did not suffer from psychosis might be able to see through it a little bit and [understand] some of [the information] may not be accurate.

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In this interview, Miller discusses patients using ChatGPT for mental health advice, risks in severe mental illness, and how clinicians respond.

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Patients Bring ChatGPT to Psychiatry Visits, With Richard Miller, MD

EPI Explained: Symptoms, Diagnosis Challenges, and Treatment Gaps

 is an underrecognized yet clinically significant condition that can profoundly affect digestive health and nutritional status. Characterized by inadequate pancreatic enzyme activity, EPI often presents with nonspecific gastrointestinal symptoms that overlap with more common disorders, making it easy to miss in routine practice.

EPI is increasingly recognized, but remains frequently underdiagnosed in clinical practice.

Symptoms are often nonspecific, including chronic diarrhea, bloating, and abdominal discomfort.

High-risk patients include those with chronic pancreatitis, pancreatic cancer, IPMNs, or prior pancreatic surgery.

Diagnosis is challenging due to limitations of current tests, including fecal fat collection and fecal elastase.

Pancreatic enzyme replacement therapy (PERT) is the cornerstone of treatment, but delays in diagnosis and limited therapeutic options remain key unmet needs.

In a recent discussion, Sarah Enslin, PA-C, and Jennifer Geremia, PA-C, highlighted the evolving understanding of EPI, emphasizing the growing awareness of the condition, the challenges that continue to delay diagnosis, and the critical need for more effective testing and treatment strategies to improve patient outcomes.

Both experts pointed to the need for greater clinical awareness and improved diagnostic strategies for EPI, a condition they say is often overlooked despite its significant impact on patients.

Reflecting on trends in clinical practice, Enslin noted that EPI is not a new diagnosis, but rather one that clinicians are recognizing more frequently as awareness improves. In her view, the condition has likely been underdiagnosed for years, only now gaining broader attention as providers become more attuned to its presentation and associated risk factors.

Geremia echoed this sentiment, stressing that EPI should remain firmly in the differential diagnosis for patients with compatible symptoms and comorbidities. Both underscored that missing the diagnosis can have meaningful consequences, including poor quality of life and nutritional deficiencies.

The speakers highlighted the nonspecific nature of EPI symptoms as one of the greatest barriers to diagnosis. As Enslin explained, patients commonly present with vague complaints such as chronic diarrhea, bloating, and abdominal discomfort, all of which are symptoms that can easily be attributed to more common gastrointestinal disorders. While clinicians often associate EPI with chronic pancreatitis or cystic fibrosis, both experts emphasized the importance of broadening that perspective, pointing to additional at-risk populations, including patients with pancreatic cancer, intraductal papillary mucinous neoplasms, or a history of pancreatic surgery.

Geremia expanded this discussion beyond classic pancreatic disease, noting that EPI may also be missed in patients with less obvious pancreatic abnormalities, such as cysts or atrophy. They further emphasized that certain non-pancreatic conditions, such as prior gastric bypass surgery, inflammatory bowel disease, and celiac disease, should also prompt consideration of EPI, as it may coexist and go unrecognized.

Diagnostic challenges also remain a key issue. Enslin described the gold standard 72-hour fecal fat test as impractical for most patients, while the more commonly used fecal elastase test, though convenient, has notable limitations in accuracy. Both experts suggested that newer approaches, including breath or serum-based testing, could help address these gaps if validated and adopted more widely.

When discussing management, both experts pointed to pancreatic enzyme replacement therapy (PERT) as the cornerstone of treatment. As Enslin explained, therapy is individualized based on symptom improvement, with goals centered on reducing stool frequency, improving consistency, and alleviating bloating to enhance overall quality of life. However, they also identified important unmet needs, including the lack of non-porcine enzyme formulations for patients with dietary restrictions.

Ultimately, both experts agreed that while progress has been made in recognizing EPI, delays in diagnosis remain common. They stressed that continued efforts to improve awareness, refine diagnostic tools, and expand treatment options will be essential to improving outcomes for patients.

Editors’ note: Enslin reports no relevant disclosures. Geremia reports relevant disclosures with Madrigal, Ipsen, Pfizer, AbbVie, and others.

Cleveland Clinic. Exocrine Pancreatic Insufficiency (EPI). June 10, 2021. Accessed April 15, 2026. 

https://my.clevelandclinic.org/health/diseases/21577-exocrine-pancreatic-insufficiency-epi

NIDDK. Definition & Facts for Exocrine Pancreatic Insufficiency. January 2023. Accessed April 15, 2026. 

https://www.niddk.nih.gov/health-information/digestive-diseases/exocrine-pancreatic-insufficiency/definition-facts

Drugs.com. Medications for Pancreatic Exocrine Dysfunction. April 15, 2026. 

https://www.drugs.com/condition/pancreatic-exocrine-dysfunction.html

Sarah Enslin, PA-C, and Jennifer Geremia, PA-C, discuss the diagnosis and management of EPI, reflecting on ongoing challenges in the field.

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, IBS and IBD, Crohn's disease, and more.

Exocrine Pancreatic Insufficiency

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Missed and Misunderstood: The Ongoing Challenges of Exocrine Pancreatic Insufficiency

Is TSW Becoming More Accepted in Dermatology? With Brad P. Glick, DO, MPH

Topical steroid withdrawal (TSW) syndrome is considered by some to be a controversial topic in the 

 world today, but it is becoming more widely discussed among clinicians and patients.

Brad Glick, DO, MPH, a board-certified dermatologist and dermatologic surgeon known for his role at the Glick Skin Institute, spoke with the 

 in Denver, Colorado, about this topic and others covered in his session at the conference. He was first asked whether TSW is becoming more accepted as a real condition in the dermatology space.

“[Just] ask the country of Canada…and Great Britain, where there are now specific warnings and package inserts for topical corticosteroids, about TSW,” Glick expressed.

He addressed the growing recognition of TSW, describing the condition as increasingly supported by emerging research and international regulatory acknowledgment around the world. Glick added, despite some remaining skepticism within the dermatology community, that mounting data and patient presentations are contributing to TSW’s broader acceptance as a real condition.

From a clinical standpoint, he described several characteristic features to aid clinicians in their identification of TSW. Such characteristics include diffuse erythema, especially involving the face, as well as more distinctive findings such as the “sleeve sign.” This sign is marked by the sharp demarcation of erythema located on patients’ wrists or ankles, as well as erythema of the lower extremities.

Glick further referenced recent mechanistic insights suggesting a potential role for metabolic pathways, including NADH-related processes, in driving rebound inflammation following chronic or moderate topical corticosteroid use, potentially helping to clarify the pathophysiology underlying TSW.

Additionally, he pointed to the role of patient awareness and social media in amplifying recognition of TSW. Specifically, Glick described a marked increase in inquiries among patients following educational presentations on the subject. Despite acknowledgement of online discourse sometimes overstating various concerns, he emphasized that clinicians are encountering individuals with symptoms aligned with TSW in clinical practice.

 with a broader perspective on therapeutic innovations in dermatology in 2026. Glick pointed to the expansion of non-steroidal topical agents’ availabilities as a notable advancement, adding that such shifts may help patients’ disease control and may diminish their reliance on intermittent corticosteroid use. Later, Glick noted the sustained impact of biologic drugs in the current armamentarium, particularly in psoriasis and atopic dermatitis.

Looking ahead, Glick expressed optimism regarding the development of novel oral medications, and this was described by Glick as especially true for psoriasis. Such developments may complement existing biologic and topical options for patients with dermatologic diseases. Nevertheless, the critical barrier of access was cited by Glick as remaining, with prior authorization requirements being described as a persistent obstacle.

The quotes used in this interview summary were edited for clarity.

Glick has served as an adviser, consultant, speaker, or investigator for Amgen, AbbVie, AstraZeneca, Almirall, Arcutis, Bausch Health/Valeant, Ortho Dermatologics, Boehringer Ingelheim, Bristol-Myers Squibb, Brickell Biotech, Cara, ChemoCentryx, Dermavant, Dermira, Eli Lilly, EPI/Novan, Incyte, Janssen Pharmaceuticals, LEO Pharma, Galderma, Nimbus Lakshmi, Inc, Novartis, Sun Pharma, Pfizer, Sanofi, Regeneron, UCB and the CorEvitas AD, CorEvitas PSO, and PROSE Registries and is a shareholder of Top MD

Lio P. Addressing Doubts About Topical Steroid Withdrawal (TSW), with Peter Lio, MD. HCPLive. June 10, 2025. Accessed December 12, 2025. 

https://www.hcplive.com/view/addressing-doubts-about-topical-steroid-withdrawal-tsw-peter-lio-md

Glick B, et al. S065 What's New in Dermatology. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.

In this interview from AAD 2026, Glick speaks about key insights on topical steroid withdrawal (TSW) and on the future of dermatology.

Patrick Campbell is the editorial director of HCPLive. Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter and/or multimedia specialist with the Pocono Record, Star News Group, and NJ Advance Media. He is the executive producer for multiple HCPLive podcasts, including Diabetes Dialogue, Don't Miss a Beat, Kidney Compass, Medical Ethics Unpacked, The Medical Sisterhood, and Skin of Color Savvy. 


Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

The FDA has accepted LEO Pharma's sNDA for delgocitinib cream for moderate-to-severe chronic hand eczema in adolescents. 

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Cardiovascular and Cardiometabolic Risk in HS Demands Greater Clinical Attention, With Raj Chovatiya, MD, PhD

Once-Weekly Navepegritide Safe and Efficacious for Achondroplasia, With Carlos Bacino, MD

Patients Bring ChatGPT to Psychiatry Visits, With Richard Miller, MD

Missed and Misunderstood: The Ongoing Challenges of Exocrine Pancreatic Insufficiency

Is TSW Becoming More Accepted in Dermatology? With Brad P. Glick, DO, MPH