Original article
Increased prevalence of subclinical atherosclerosis in patients with hidradenitis suppurativa (HS)

https://doi.org/10.1016/j.jaad.2016.03.025Get rights and content

Background

Chronic inflammatory diseases have been associated with increased prevalence of subclinical atherosclerosis. Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving intertriginous skin.

Objective

We sought to investigate the potential association between HS and subclinical atherosclerosis.

Methods

This study included 68 patients with HS and 136 age- and sex-matched healthy control subjects. Patients with history of cardiovascular events, diabetes mellitus, chronic kidney disease, or another concomitant inflammatory condition were excluded. Carotid intima-media thickness and carotid plaques were measured by carotid ultrasonography. Adjustments were made for age, sex, and traditional cardiovascular risk factors.

Results

Patients had greater carotid intima-media thickness values than control subjects (0.615 ± 0.097 vs 0.578 ± 0.098 mm; P = .012). Carotid plaques were also more frequent in patients than in control subjects (30.9% vs 22.1%). In the multivariable regression model adjusted for age, sex, and traditional cardiovascular risk factors, HS was significantly related to the presence of carotid plaques (odds ratio 2.99, 95% confidence interval 1.26-7.13; P = .013).

Limitations

Causality could not be assessed.

Conclusions

These results indicate an increased frequency of subclinical atherosclerosis in patients with HS. Accordingly, HS should be considered a disease associated with potentially increased cardiovascular risk.

Section snippets

Patients and control subjects

We performed a cross-sectional case-control study at the Hospital Universitario Marqués de Valdecilla (Santander, Spain). From February 2014 to March 2015, consecutive Caucasian patients with an appropriate diagnosis of HS were recruited from our dermatology outpatient clinic. The diagnosis of HS was made by dermatologists. Diagnostic criteria were established as follows, and all 3 criteria were necessary to establish the diagnosis: (1) presence of typical lesions: nodules (inflammatory or

Demographic, clinical, and laboratory data

A total of 68 patients with HS and 136 healthy control subjects were studied. The main demographic and clinical characteristics are summarized in Table II. The mean age did not significantly differ between the patients with HS and control subjects. The gender distribution for both groups was similar. According to the HS-PGA, 29 patients (42.6%) were classified as having minimal-mild HS (HS-PGA score <3) and the remaining 39 (57.4%) as having moderate-severe/very severe HS (HS-PGA score ≥3). The

Discussion

The results of this study show that patients with HS without clinically evident CVD have a higher prevalence of subclinical atherosclerosis by exhibiting a greater cIMT than control subjects matched for age and sex. Carotid plaques were also more frequently observed in patients with HS than in control subjects. However, this difference was only statistically significant between the subgroup of patients with moderate-severe/very severe HS (HS-PGA score ≥3) and the control group. In fact, we have

References (34)

  • R.G. Elsheikh et al.

    Evaluation of subclinical atherosclerosis in Egyptian psoriatic patients

    J Saudi Heart Assoc

    (2014)
  • J. Revuz

    Hidradenitis suppurativa

    J Eur Acad Dermatol Venereol

    (2009)
  • G.B. Jemec

    Clinical practice. Hidradenitis suppurativa

    N Engl J Med

    (2012)
  • I. Cosmatos et al.

    Analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States

    J Am Acad Dermatol

    (2013)
  • G. Kelly et al.

    Hidradenitis suppurativa: the role of immune dysregulation

    Int J Dermatol

    (2014)
  • L. Matusiak et al.

    Increased serum tumor necrosis factor-alpha in hidradenitis suppurativa patients: is there a basis for treatment with anti-tumor necrosis factor-alpha agents?

    Acta Derm Venereol

    (2009)
  • H.H. van der Zee et al.

    Elevated levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-α and IL-1β

    Br J Dermatol

    (2011)
  • Cited by (0)

    Drs González-Gay and Blanco share senior authorship.

    Supported by an unrestricted grant from Abbvie Inc.

    Disclosure: Dr González-Gay received grant funding from Abbvie. Drs González-López, Hernández, Lacalle, Mata, López-Escobar, López-Mejías, Corrales, González-Vela, and Blanco, Ms Portilla, and Ms Fuentevilla have no conflicts of interest to declare. The opinions expressed in this article are those of the authors and do not necessarily represent those of Abbvie Inc.

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