Hidradenitits Suppurativa Linked to Increased Risk of Cardiovascular Diseases

A recent study found patients with hidradenitis suppurativa had an increased risk of developing cardiovascular diseases (CVDs).¹

“This is the most extensive study on the association of HS with CVD,” wrote investigators, led by Piotr K. Krajewski, MD, PhD, from the department of dermatology, venerology and allergology, at Wroclaw Medical University in Poland. “This indicates that [hidradenitis suppurativa] may be an independent risk factor for the development of those comorbidities.”

In the past hidradenitis suppurativa was viewed as an orphan disease. However, recent epidemiological studies found the prevalence of the disorder was 1% of the population.²

Young adults and women are the ones most affected by hidradenitis suppurativa. The disorder impacts intertriginous areas, armpits, groins, submammary, and anogenital areas.

Hidradenitis suppurativa can lead to “rope-like scarring” and is linked to chronic severe pain and itch, foul smell, skin contractions, and movement impairment. The condition hinders quality of life with a burden comparable to patients with congestive heart failure or depression.

Patients with hidradenitis suppurativa often have comorbid conditions—diabetes, metabolic syndrome, and hyperlipidemia—making them more susceptible to developing CVDs.

Investigators sought to assess the risk of patients with hidradenitis suppurativa developing CVDs. They conducted a large, propensity-matched global retrospective cohort study with 144,100 patients with hidradenitis suppurativa and 144,100 healthy controls. Participants were matched based on demographics and history of diseases relevant to CVDs, such as diabetes, obesity, and nicotine dependence.

Participants with the hidradenitis suppurativa cohort had a mean age of 35.8 ± 15.0 years and were mostly female (75.2%), White (46.7%), and not Hispanic or Latino (70%).

The team identified 90 cardiovascular disorders among the sample, which were broken into 6 groups: ischemic heart and brain disease, heart failure, vascular disorders, disorders of myo- and pericardial disease, conduction disorders, and valve disorders.

They saw patients with hidradenitis suppurativa demonstrated greater frequency in excess weight (25%) or obesity (14.4%), nicotine dependence, and diabetes mellitus. However, this cohort had lower odds of primary hypertension compared to the controls.

“One should remember that [hidradenitis suppurativa] patients are frequently burdened with additional CV risk factors, including obesity, [diabetes mellitus], and dyslipidemias, which raise the CV risk even higher,” investigators wrote.

Overall, 47 CVDs were significantly linked to an increased risk of onset in patients with hidradenitis suppurativa (P = .0001). The greatest risk was for unspecified heart failure, followed by myocardial infarction.

Top 10 CVDs with the Greatest Risk

1. Heart failure, unspecified (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.950 – 2.258; P = .001)
2. Old myocardial infarction (HR, 2.06; 95% CI, 1.875 – 2.268; P = .00011)
3. Acute embolism and thrombosis of unspecified deep veins of lower extremity (HR, 1.93; 95% CI, 1.736 – 2.142; P = .0001)
4. Hypertensive heart disease with heart failure (HR, 1.89; 95% 1.733 – 2.054; P = .0001)
5. Pulmonary heart disease and diseases of pulmonary circulation (HR, 1.857; 95% 1.734 – 1.990; P = .0001)
6. Systolic (congestive) heart failure (HR, 1.84; 95% CI, 1.678 – 2.021; P = .0001)
7. Diastolic (congestive) heart failure (HR, 1.83; 95% CI, 1.682 – 1.983; P = .0001)
8. Acute embolism and thrombosis of deep veins of lower extremity (HR, 1.82, 95% CI, 1.659 – 1.995; P = .0001)
9. Pulmonary embolism (HR, 1.80; 95% CI, 1.635 – 1.976; P = .0001)
10. Hypertensive heart disease (HR, 1.77; 95% CI, 1.645 – 1.909; P = .0001)

Furthermore, patients with hidradenitis suppurativa suffered often from conduction disorders during the observation period, with atrial fibrillation and flutter being the most common (HR, 1.67; 95% CI, 1.55 – 1.81). Valve disorders were the least prevalent of the cardiovascular diseases in patients with hidradenitis suppurativa but still had a greater prevalence than controls.

In contrast, patients with hidradenitis suppurativa had a reduced risk of asymptomatic varicose veins of the lower extremities had a reduced risk (HR, 0.84; 95% CI, 0.76 – 0.94).

Investigators noted some limitations, such as the sample size not taking place in 1 center and not evaluating the hidradenitis suppurativa severity and other disease characteristics.

“The results of this study clearly indicate the need for a holistic approach to patients with [hidradenitis suppurativa] and the necessity of close cooperation between dermatologists and cardiologists,” investigators concluded. “Prophylaxis of CVD should be introduced in all [hidradenitis suppurativa] patients; they should be closely monitored and treated before developing life-threatening conditions.”

References

1. ^{Krajewski PK, Matusiak Ł, Ständer S, Thaçi D, Szepietowski JC, Zirpel H. Risk of cardiovascular disorders in hidradenitis suppurativa patients: a large-scale, propensity-matched global retrospective cohort study. Int J Dermatol. Published online April 21, 2024. doi:10.1111/ijd.17186}
2. ^{Sabat R, Jemec GBE, Matusiak Ł, Kimball AB, Prens E, Wolk K. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020;6(1):18. Published 2020 Mar 12. doi:10.1038/s41572-020-0149-1}