In a nationwide cohort study that used Taiwan’s National Health Research Institute Database, researchers found that survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis had a significantly higher risk of cerebrovascular accidents and ischemic heart disease that persisted for up to 7 years.
In their study published in JAMA Dermatology, the researchers analyzed data from 1998 to 2021. They found that Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) survivors had a higher risk of cerebrovascular accidents (CVA; HR = 1.65; 95% confidence interval [CI] = 1.57-1.72) and a higher risk of ischemic heart disease (IHD; HR = 1.58; 95% CI = 1.51-1.65) compared with non-SJS/TEN patients. Mortality due to CVA was also higher than patients without SJS/TEN (HR = 1.69; 95% CI = 1.46-1.96), as was IHD-related mortality (HR = 1.55; 95% CI = 1.32-1.82).
Taiwan’s National Health Research Institute Database (NHIRD) includes medical claims data from 99% of the population. The researchers identified 10,571 SJS/TEN survivors in the CVA cohort (mean age = 56.1 years, 50.7% female) and 11,084 in the IHD cohort (mean age = 56.6 years, 50.2% female). Patients were excluded if they had preexisting CVA/IHD, were under 20 or over 90 years old, or did not have complete records.
Subgroup analyses revealed that SJS/TEN survivors over 50 years old and those who required ICU admission had the highest cardiovascular mortality risk. While no significant sex-based differences in CVA risk were found, male survivors exhibited a higher IHD mortality risk.
The findings aligned with previous studies that suggest prolonged systemic inflammation and hypercoagulability following SJS/TEN contribute to increased cardiovascular risks. "The elevated cardiovascular mortality risks peaked at 1 year after SJS/TEN and persisted for 4 to 7 years," Hsien-Yi Chiu, MD, PhD, of the Department of Medical Research at National Taiwan University Hsin-Chu Hospital in Hsinchu, Taiwan, noted with colleagues.
The researchers continued: "Given the excess burden of cardiovascular morbidity and mortality among SJS/TEN survivors, tailored monitoring and preventive strategies, such as cardiovascular risk factor modification, should be considered to minimize cardiovascular mortality in these patients."
The study’s limitations included the lack of laboratory and lifestyle data in NHIRD, which necessitated reliance on Charlson Comorbidity Index scores for baseline health assessment. Future research that incorporates more detailed clinical data is needed to validate these findings and explore potential interventions.
Full disclosures are available in the published study.
