Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Australas J Dermatol. 2024 Nov;65(7):e187-e193. doi: 10.1111/ajd.14355. Epub 2024 Aug 1.
The risk of life-threatening major cardiovascular outcomes among patients with bullous pemphigoid (BP) is inconsistent in the current literature.
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.
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.
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.
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.
在天疱疮（BP）患者中，危及生命的主要心血管结局的风险在当前文献中不一致。
评估 BP 患者心肌梗死（MI）、中风（CVA）、外周血管疾病（PVD）和肺栓塞（PE）的风险和预后结局。我们还旨在探讨不同治疗方法对这些结局风险的影响。
进行了一项基于人群的回顾性队列研究，以比较 BP 患者（n=3924）与年龄、性别和种族匹配的对照受试者（n=19280）的 MI、CVA、PVD 和 PE 事件的发生率。通过多变量 Cox 回归分析估计调整后的危险比（HR）和 95%置信区间（CI）。数据从 Clalit 健康服务机构的计算机数据库中检索。
与匹配的对照相比，BP 患者发生 MI（完全调整 HR：1.44；95%CI：1.14-1.81；p=0.002）、CVA（完全调整 HR：1.24；95%CI：1.06-1.45；p=0.007）、PVD（完全调整 HR：1.60；95%CI：1.27-2.03；p=0.003）和 PE（完全调整 HR：1.72；95%CI：1.28-2.32；p<0.008）的风险增加。患有 BP 的患者在合并 MI（完全调整 HR：1.61；95%CI：1.44-1.81；p<0.001）、CVA（完全调整 HR：1.70；95%CI：1.52-1.89；p<0.001）、PVD（完全调整 HR：1.38；95%CI：1.20-1.58；p<0.001）和 PE（完全调整 HR：1.44；95%CI：1.10-1.88；p=0.007）时发生全因死亡率的风险增加。
BP 与 MI、CVA、PVD、PE 和心血管死亡率的风险增加相关。应在 BP 患者中实施初级、二级和三级心血管预防措施。
