Bullous pemphigoid increases cardiovascular disease mortality risk

Patients with bullous pemphigoid experienced increases in cardiovascular mortality risk at 1, 3 and 5 years compared with matched controls, according to a study.

“The role of bullous pemphigoid (BP) in cardiovascular disease mortality remains controversial, and analyses of causes of death among patients with BP based on individual data remain lacking,” Wan-Chieh Shen, MD, of the department of dermatology at China Medical University Hospital, in Taichung City, Taiwan, and colleagues wrote.

In the cohort study, Shen and colleagues assessed risk for all-cause mortality, cardiovascular disease mortality and cancer mortality in a cohort of 252 patients with BP and 1,008 matched controls. The cohort was 54.4% men, with a median age of 78 years (interquartile range, 70.3-84.8).

Eligible participants in the study arm had been diagnosed with and treated for BP between Jan. 1, 2007 and Dec. 31, 2017. Diagnosis consisted of pathological findings using direct immunofluorescence, typical clinical presentation or anti-basement membrane zone antibody test. Treatment included corticosteroid use for at least 28 cumulative days, according to the findings.

Findings at 1 year showed higher rates of cardiovascular disease mortality in the BP group compared with controls (7.9% vs. 1.3%). This trend persisted through 3 years (11.1% vs. 2.4%) and 5 years (12.3% vs. 3.9%).

Adjusted analysis results demonstrated a five-fold increase in risk for cardiovascular disease mortality in the BP group compared with controls (HR = 5.29; 95% CI, 2.4-11.68). Again, this trend persisted through 3 years (HR = 5.79; 95% CI, 3.11-10.78) and 5 years (HR = 4.95; 95% CI, 2.88-8.51).

Looking at subgroups, higher cardiovascular mortality risk compared with controls was observed in BP patients without a history of hypertension (HR = 7.28; 95% CI, 3.87-13.69). In addition, patients with BP who had no history of cardiovascular disease also experienced higher cardiovascular mortality (HR = 6.59; 95% CI, 3.4-12.79), as did patients with no prior diuretic use (HR = 5.75; 95% CI, 3.15-10.5).

Regarding all-cause mortality, patients with BP who had no experience with corticosteroids were more likely to die from cardiovascular disease than controls (HR = 5.65; 95% CI, 4.19-7.61).

“The findings of this cohort study suggest that BP was associated with a 5-fold higher risk of [cardiovascular disease] mortality, particularly in patients without underlying hypertension or [cardiovascular disease] or those without prior corticosteroid or diuretic use,” the researchers concluded.