Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom.
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Allergy Clin Immunol. 2019 May;143(5):1821-1829. doi: 10.1016/j.jaci.2018.11.030. Epub 2018 Dec 18.
Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity.
We sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes.
MEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes.
Nineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28).
Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.
特应性皮炎是一种常见的炎症性皮肤病。各种炎症状态与心血管疾病有关，后者是全球死亡率和发病率的主要原因。
我们旨在系统地综述和荟萃分析评估特应性皮炎与特定心血管结局之间关联的基于人群的研究。
我们从建库至 2017 年 12 月检索了 MEDLINE、Embase 和全球卫生数据库。我们使用随机效应荟萃分析获得汇总估计值。我们使用多元贝叶斯荟萃回归模型来估计特应性皮炎严重程度增加对心血管结局的影响斜率。
纳入了 19 项相关研究。横断面研究报告的特应性皮炎的影响具有异质性，没有证据表明与心绞痛、心肌梗死、心力衰竭或中风存在汇总关联。在队列研究中，特应性皮炎与心肌梗死（n=4；相对风险 [RR]，1.12；95%置信区间 [CI]，1.00-1.25）、中风（n=4；RR，1.10；95%CI，1.03-1.17）、缺血性中风（n=4；RR，1.17；95%CI，1.14-1.20）、心绞痛（n=2；RR，1.18；95%CI，1.13-1.24）和心力衰竭（n=2；RR，1.26；95%CI，1.05-1.51）的风险增加相关。心肌梗死和中风的预测区间较宽。心血管结局的风险似乎随严重程度的增加而增加（严重程度类别之间的平均 RR 增加，1.15；95%可信度区间，1.09-1.21；不确定性区间，1.04-1.28）。
在队列研究中，与心血管结局的显著关联更为常见，但存在较大的研究间异质性。特应性皮炎严重程度增加与心血管结局的风险增加相关。有必要提高利益相关者对这种小但显著关联的认识。
