Atopic dermatitis linked to increased risk of atrial fibrillation

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Patients with moderate-to-severe atopic dermatitis may have a 20% increased risk of atrial fibrillation, suggests a study published in the Journal of the American Academy of Dermatology.¹

Atrial fibrillation is common – affecting 4% of individuals 60 years or older – and carries with it an increased risk of stroke.² Research has shown that inflammation is significant risk factor for developing atrial fibrillation, as patients with inflammatory disease such as rheumatoid arthritis, psoriasis or individuals with inflammatory biomarkers have been shown to be have an increased risk of atrial fibrillation.^3,4

RELATED: More evidence of cardiovascular disease in atopic eczema

The authors of the study speculated that patients with atopic dermatitis might also have an increased risk for atrial fibrillation because of the presence of low-grade inflammation due to the disease and the increased prevalence of cardiovascular risk factors, such as obesity, hypertension and diabetes, among this group.^5,6

To test their hypothesis, they conducted a nationwide population-based 35-year cohort study to examine whether patients in Denmark with hospital-diagnosed moderate-to-severe atopic dermatitis were at long-term increased risk of atrial fibrillation.

Using the Danish National Patient Registry (DNPR) they identified patients born in Denmark between  January 1, 1947 and January 1, 1983 who had received a hospital diagnosis of atopic dermatitis from January 1, 1977 until January 1 2013 and matched each with ten individuals of the same sex and birth year. Patients were followed up until death, emigration, atrial fibrillation diagnosis or until 2013.

In total, 13,126 patients with atopic dermatitis and 124,211 comparators were followed for a median of 19.3 years. Using these data, the researchers calculated that the 35-year risk of atrial fibrillation was 0.81% for patients with atopic dermatitis and 0.67% for comparators without the condition. This meant that the hazard ratio for atrial fibrillation was 1.2 for patients with atopic dermatitis. 

Female patients, those diagnosed with atopic dermatitis at a young age and those with a greater disease severity faced a particularly high risk of atrial fibrillation. The hazard ratio for the condition for women with atopic dermatitis compared to males was 1.6, and it was also 1.6 in patients diagnosed between birth and aged 19 as opposed to a later age. In addition, the hazard ratio for diagnosis of atrial fibrillation was 1.7 for patients with allergic asthma/rhinitis compared to patients without.

RELATED: Heart disease risk high in atopic eczema

“This long-term follow-up study shows evidence that hospital-diagnosed atopic dermatitis is associated with a 20% increased relative risk of atrial fibrillation,” writes the study authors. “Although the clinical implications are limited by a low absolute risk of atrial fibrillation, the typical early onset of atopic dermatitis may provide clinicians with a unique opportunity for promoting a heart healthy lifestyle to reduce risk for cardiovascular disease, including atrial fibrillation.”
They suggested that systemic inflammation was likely to underly the association for the increased risk of atrial fibrillation in patients with atopic dermatitis, as it was presumed to rheumatoid disorders and psoriasis. However, they added that it was also possible that arrhythmogenic effects of atopic dermatitis treatments might also play a role.

References:

1. Schmidt SAJ, Olsen M, Schmidt M, et al. Atopic dermatitis and risk of atrial fibrillation or flutter: a 35-year follow-up study. Journal of the American Academy of Dermatology (2019);

2. Page RL. Clinical practice. Newly diagnosed atrial fibrillation. N Engl J Med. 2004;351(23):2408–2416.

3. Lazzerini PE, Capecchi PL, Laghi-Pasini F. Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis. Eur Heart J. 2017;38(22):1717–1727. 

4. Upala S, Shahnawaz A, Sanguankeo A. Psoriasis increases risk of new-onset atrial fibrillation: a systematic review and meta-analysis of prospective observational studies. J Dermatolog Treat. 2017;28(5):406–410.

5.  Silverberg JI, Becker L, Kwasny M et al. Central obesity and high blood pressure in pediatric patients with atopic dermatitis. JAMA Dermatol. 2015;151(2):144–152.

6. Silverberg JI, Greenland P. Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol. 2015;135(3):721–8.e726.