Vitiligo Identified as Possible Risk Factor for Cardiovascular Disease

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Vitiligo may be a potential risk factor for cardiovascular disease, according to a new meta-analysis.¹ In this novel systemic review, researchers analyzed comorbidities and factors linked to the risk of cardiovascular diseases in vitiligo patients. The connection between the 2 diseases has previously been uncertain.

The results indicated that patients with vitiligo who had high levels of insulin, cholesterol, and other factors may have a higher risk of developing cardiovascular issues. Lifestyle choices such as smoking and alcohol consumption could also increase this likelihood.

To review the evidence, the investigators conducted a search for relevant studies in PubMed, EMBASE, and Cochrane Central Register databases published up to November 2023. From these eligible studies, various data such as study design, number of participants, and disease duration, were extracted. The Newcastle-Ottawa Scale was used to assess the quality of each study. After removing duplicates, reviewing titles, and screening abstracts, 74 studies were ultimately used for the analysis. These observational studies included a total of 35,362 participants with vitiligo.

The primary results demonstrated that vitiligo had comorbidity with metabolic syndrome, diabetes, obesity, hypertension, and hyperlipidemia. Metabolic syndrome was recorded in 28.3% of participants (95% CI: 0.224, 0.345; p < 0.001) while 6.0% had diabetes mellitus (95% CI: 0.041, 0.082; p < 0.001). Hyperlipidemia was found in 43.0% of patients (95% CI: 0.223, 0.650; p < 0.001) and 15.8% of participants had hypertension (95% CI: 0.061, 0.286; p = 0.001). Additionally, 38.5% of patients were obese (95% CI: 0.089, 0.681; p = 0.011). Thus, patients with vitiligo were more likely to have complications related to one or more of these diseases.

The study also showed that vitiligo patients have significantly higher levels of fasting blood glucose, serum insulin, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoproteins, C-reactive protein, homeostasis model assessment of insulin resistance, systolic blood pressure, diastolic blood pressure,and homocysteine. These can all be linked to cardiovascular issues.

Additionally, the researchers explained that lifestyle behaviors such as smoking and alcohol consumption could increase the risk of cardiovascular disease, as the number of vitiligo patients who participated in these behaviors was significantly higher than those without. In contrast, there were some tested factors that were not related to cardiovascular disease in patients with vitiligo. Investigators observed no association based on waist circumference, phospholipid levels, and body mass index (BMI).

The researchers acknowledged their study’s limitations, one being the significant heterogeneity among the utilized studies. They also noted that the limited number of eligible high-quality data may affect the precision of their findings. 

Despite this existing research, the exact correlation between the 2 diseases has remained unclear. For example, a previous study from 2021 recognized a relationship between vitiligo and cardiovascular diseases.² Conversely, a case-control study performed in Spain gave opposing results.³ Overall, the authors concluded that although the connection between vitiligo and cardiovascular disease is not yet fully understood, this study is a promising start. Future research that more closely identifies the exact cardiovascular diseases related to vitiligo is recommended.

“Considering the controversial reports on the relationship between vitiligo and cardiovascular diseases and whether patients with vitiligo are at a higher risk of cardiovascular disease than healthy controls, a systematic review and meta-analysis are urgently needed to illustrate this relationship, increase our understanding of the strength of their correlation, and provide updated data references for performing relevant medical services and clinical interventions,” the authors wrote.

References

1. Liang X, Guo F, Zhang M, et al. Risk factors for cardiovascular diseases in patients with vitiligo: an analysis of current evidence. Ann Med. 2024;56(1):2326297. doi:10.1080/07853890.2024.2326297

2. Namazi N, Amani M, Haghighatkhah HR, Noori E, Abdollahimajd F. Increased risk of subclinical atherosclerosis and metabolic syndrome in patients with vitiligo: a real association or a coincidence?. Dermatol Ther. 2021;34(2):e14803. doi:10.1111/dth.14803

3. Rodríguez-Martín M, de Paz NM, Mehtani P, et al. Patients with vitiligo present fewer cardiovascular risk factors: results from a case-control study. J EurAcad Dermatol Venereol. 2013;27(1):124-125. doi:10.1111/j.1468-3083.2011.04392.x