Pediatric and adolescent patients with atopic dermatitis did not consistently demonstrate higher cardiometabolic risk scores or abnormalities in blood pressure, lipid levels, or imaging measures in a UK birth cohort, according to a recent study.
In the study, investigators included 9,281 participants from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort that recruited pregnant women with expected delivery dates from April 1, 1991, to December 31, 1992. They analyzed data collected from 1991 to 2017.
Active atopic dermatitis (AD) was defined as at least two positive reports of itchy, dry skin rash in the joints and creases of the body in the past year, including at the current assessment age. Parents reported symptoms at 11 time points from infancy through childhood, and the participants self-reported symptoms at ages 16 and 18 years. Disease severity was grouped as no problem, mild, very bad, or quite bad.
The primary outcome was a validated cardiometabolic risk score calculated at ages 15, 17, and 24 years from systolic and diastolic blood pressure, abdominal fat mass, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C). Secondary outcomes included body mass index (BMI), blood pressure, lipid profiles, and ultrasonography-based measures of subclinical atherosclerosis, including carotid artery intima media thickness and pulse wave velocity.
Active AD was present in about 13% to 22% of the participants aged 3 to 18 years. Among those with AD, 4% to 7% of them reported moderate or severe disease at each age.
In adjusted linear regression models, the investigators found no evidence of an association between active AD and cardiometabolic risk scores at age 15 years or 17 years (adjusted mean difference = 0.11 vs 0.09 standard deviations).
Across 49 comparisons of individual cardiovascular risk factors, just two nominal associations were reported, both involving low-density lipoprotein cholesterol (LDL-C). Active AD was associated with lower LDL-C at age 3 years and higher LDL-C at age 10 years. The investigators reported no consistent dose-response pattern by AD severity.
They also assessed five longitudinal AD trajectory phenotypes from birth through age 14 years: severe-frequent, moderate-frequent, moderate-declining, mild-intermittent, and unaffected or rarely affected. These trajectories were not consistently associated with BMI, systolic blood pressure, total cholesterol, LDL-C, triglycerides, cardiometabolic risk scores, carotid artery intima media thickness, or pulse wave velocity at ages 17 and 24 years.
Several isolated findings reached nominal significance. Moderate-frequent AD at age 17 years and severe-frequent AD at age 24 years were associated with lower HDL-C. Mild-intermittent AD at age 17 years was associated with slightly higher diastolic blood pressure, and moderate-declining AD was associated with slightly higher pulse wave velocity at age 17 years. No other associations were observed between AD trajectory and BMI, systolic blood pressure, total cholesterol, LDL-C, triglycerides, or cardiometabolic risk scores.
The findings added to mixed evidence on AD and cardiovascular disease risk, particularly because prior studies involving pediatric patients were often cross-sectional and less consistently adjusted for BMI. The investigators noted that this analysis included repeated measures of AD activity and severity, multiple cardiovascular risk markers, and adjustment for potential confounders, including BMI, tobacco smoke exposure, traffic exposure, asthma or wheeze, and hay fever.
Limitations included attrition over more than 2 decades of follow-up, limited detailed skin measures, no correction for multiple testing, a predominantly White cohort, and relatively few participants with severe AD. The investigators noted that future studies in more diverse populations and in pediatric patients with more severe disease or elevated inflammatory markers may be needed to assess generalizability.
“In conclusion, this cohort study of children and adolescents in the UK with predominantly mild AD found no evidence for increased early cardiovascular risk in this population,” wrote lead study author Morgan Ye, MPH, of the Department of Dermatology at the University of California, San Francisco, and colleagues.
The study was supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases. Co–study author Charles E. McCulloch, PhD, reported support from the National Center for Advancing Translational Sciences of the National Institutes of Health through a University of California, San Francisco Clinical and Translational Science Institute grant during the study. Co–study author Sinéad M. Langan, MSc, PhD, reported grant funding from Wellcome Trust and EU Horizon 2020 outside the submitted work. Senior study author Katrina Abuabara, MA, MD, MSCE, reported personal fees from Amgen, Apogee, Astria, Incyte Derm, Medidata, Nektar Therapeutics, Sanofi, and TARGET REW, as well as grants from Cosmetique Internacional SNC and Pfizer outside the submitted work. The study authors reported no other conflicts of interest.
Source: JAMA Network Open
