TY - JOUR
T1 - The cardiovascular risk in bullous pemphigoid
T2 - Insights from a population-based study
AU - Kridin, Khalaf
AU - Goychberg, Rina
AU - Kridin, Mouhammad
AU - Kafri, Niv
AU - Barhoum, Masad
AU - Cohen, Arnon D.
N1 - Publisher Copyright:
© 2024 The Author(s). Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Background: The risk of life-threatening major cardiovascular outcomes among patients with bullous pemphigoid (BP) is inconsistent in the current literature. Objective: To evaluate the risk and prognostic outcomes of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD) and pulmonary embolism (PE) in patients with BP. We additionally aimed to explore the influence of different therapeutic approaches on the risk of these outcomes. Methods: A population-based retrospective cohort study was conducted to compare BP patients (n = 3924) with age-, gender- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of MI, CVA, PVD and PE. Adjusted hazard ratio (HR) and 95% confidence intervals (CI) were estimated by multivariate Cox regression analysis. Data were retrieved from Clalit Health Services' computerized database. Results: Relative to their matched controls, patients with BP were at an elevated risk of MI (fully-adjusted HR: 1.44; 95% CI: 1.14–1.81; p = 0.002), CVA (fully-adjusted HR: 1.24; 95% CI: 1.06–1.45; p = 0.007), PVD (fully-adjusted HR: 1.60; 95% CI: 1.27–2.03; p = 0.003) and PE (fully-adjusted HR: 1.72; 95% CI: 1.28–2.32; p < 0.008). Patients with BP experienced heightened risk of all-cause mortality in the presence of comorbid MI (fully-adjusted HR: 1.61; 95% CI: 1.44–1.81; p < 0.001), CVA (fully-adjusted HR: 1.70; 95% CI: 1.52–1.89; p < 0.001), PVD (fully-adjusted HR: 1.38; 95% CI: 1.20–1.58; p < 0.001) and PE (fully-adjusted HR: 1.44; 95% CI: 1.10–1.88; p = 0.007). The therapeutic approach utilized to manage BP did not significantly influence the risk of cardiovascular outcomes. Conclusions: BP is associated with an elevated risk of MI, CVA, PVD, PE and cardiovascular mortality. Primary, secondary and tertiary cardiovascular prevention measures should be implemented among patients with BP.
AB - Background: The risk of life-threatening major cardiovascular outcomes among patients with bullous pemphigoid (BP) is inconsistent in the current literature. Objective: To evaluate the risk and prognostic outcomes of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD) and pulmonary embolism (PE) in patients with BP. We additionally aimed to explore the influence of different therapeutic approaches on the risk of these outcomes. Methods: A population-based retrospective cohort study was conducted to compare BP patients (n = 3924) with age-, gender- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of MI, CVA, PVD and PE. Adjusted hazard ratio (HR) and 95% confidence intervals (CI) were estimated by multivariate Cox regression analysis. Data were retrieved from Clalit Health Services' computerized database. Results: Relative to their matched controls, patients with BP were at an elevated risk of MI (fully-adjusted HR: 1.44; 95% CI: 1.14–1.81; p = 0.002), CVA (fully-adjusted HR: 1.24; 95% CI: 1.06–1.45; p = 0.007), PVD (fully-adjusted HR: 1.60; 95% CI: 1.27–2.03; p = 0.003) and PE (fully-adjusted HR: 1.72; 95% CI: 1.28–2.32; p < 0.008). Patients with BP experienced heightened risk of all-cause mortality in the presence of comorbid MI (fully-adjusted HR: 1.61; 95% CI: 1.44–1.81; p < 0.001), CVA (fully-adjusted HR: 1.70; 95% CI: 1.52–1.89; p < 0.001), PVD (fully-adjusted HR: 1.38; 95% CI: 1.20–1.58; p < 0.001) and PE (fully-adjusted HR: 1.44; 95% CI: 1.10–1.88; p = 0.007). The therapeutic approach utilized to manage BP did not significantly influence the risk of cardiovascular outcomes. Conclusions: BP is associated with an elevated risk of MI, CVA, PVD, PE and cardiovascular mortality. Primary, secondary and tertiary cardiovascular prevention measures should be implemented among patients with BP.
KW - bullous pemphigoid
KW - cardiovascular
KW - cerebrovascular attack
KW - epidemiology
KW - myocardial infarction
KW - peripheral vascular disease
KW - pulmonary embolism
KW - risk
UR - http://www.scopus.com/inward/record.url?scp=85200107357&partnerID=8YFLogxK
U2 - 10.1111/ajd.14355
DO - 10.1111/ajd.14355
M3 - Article
C2 - 39087452
AN - SCOPUS:85200107357
SN - 0004-8380
JO - Australasian Journal of Dermatology
JF - Australasian Journal of Dermatology
ER -