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Moderate to severe atopic dermatitis may increase risk for atrial fibrillation

Patients with moderate to severe atopic dermatitis had a 20% increase in the long-term risk for atrial fibrillation although the absolute risk remains low, according to findings from a 35-year cohort study.

“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,” Sigrun A.J. Schmidt, PhD, of the department of clinical epidemiology and department of dermatology at Aarhus University Hospital in Denmark, and colleagues wrote.

Researchers used population-based Danish registries to identify 13,126 subjects with a hospital diagnosis of atopic dermatitis from 1977 to 2013 and 124,211 individuals in a comparison cohort. Subjects were followed until death, emigration, atrial fibrillation diagnosis or 2013, with a median follow-up of 19.3 years. The Danish National Patient Registry was used to obtain information on all inpatient or outpatient primary or secondary diagnoses of atrial fibrillation.

After 35 years of follow-up, the cumulative incidence proportion of atrial fibrillation was 0.81% in the atopic dermatitis group and 0.67% in the comparison group. In subjects with atopic dermatitis vs. comparator subjects, the corresponding unadjusted HR was 1.2 (95% CI, 1.0-1.6).

The HR was 1.6 in female subjects vs. 1.0 in male subjects, and the HR was greater at 1.6 in those 19 years or younger at diagnosis vs. 1.0 to 1.1 in older age groups. The HR was 1.1 for moderate atopic dermatitis (95% CI, 0.8-1.6) and 1.3 for severe atopic dermatitis (95% CI, 0.9-1.8).

“There were no substantial changes in estimates when analyzing with delayed entry or when using phototherapy as a proxy for severe atopic dermatitis in addition to other systematic therapies and admissions,” Schmidt and colleagues wrote.

Systemic inflammation may be the underlying mechanism, similar to the proposed link between psoriasis and rheumatic disorders and atrial fibrillation, according to the researchers.

The study lacked clinical information on disease severity or activity, and severe disease was defined by the use of systemic treatments, which could decrease inflammation and lead to underestimates for the severe category, they wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.