10.5826/dpc.1304a201
text/xml
2160-9381
3149
en
Martin Steinhoff
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
meta-analysis
Hidradenitis Suppurativa and Risk of Myocardial Infarction: A Plausible Association?
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-10-31
2023-01-12
2023-10-31
2024-01-15
e2023201
Dermatol Pract Concept
Martin Steinhoff
2023/10/31
10.5826/dpc.1304a201
e2023201
Translational Research Institute, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar; Qatar University, Medical School, Doha, Qatar; Dept. of Dermatology, Weill Cornell Medicine, New York, NY, USA
2160-9381
meta-analysis
en
e2023201
Miller IM, Ahlehoff O, Ibler K, Rytgaard H, Mogensen UB, Ellervik C, Jemec GB. Hidradenitis suppurativa may not be associated with venous thromboembolia: Results from a large Danish cross-sectional study. J Dermatol Sci. 2016 Jan;81(1):61-3.
Hidradenitis Suppurativa and Risk of Myocardial Infarction: A Plausible Association?
https://dpcj.org/index.php/dpc/article/download/3149/2392
    Hidradenitis Suppurativa and Risk of Myocardial
          Infarction: A Plausible Association?
                                   Husein Husein-ElAhmed1,2, Martin Steinhoff2-6


1 Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain
2 Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
3 Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar
4 Weill Cornell Medicine-Qatar, College of Medicine, Doha, Qatar
5 Qatar University, Medical School, Doha, Qatar
6 Deptartment of Dermatology, Weill Cornell Medicine, New York, NY, USA



Key words: myocardial infarction, hidradenitis suppurativa, systemic inflammation, hazard rate, meta-analysis
Citation: Hussein-ElAhmed H, Steinhoff M. Hidradenitis Suppurativa and Risk of Myocardial Infarction: A Plausible Association?
Dermatol Pract Concept. 2023;13(4):e2023201. DOI: https://doi.org/10.5826/dpc.1304a201
Accepted: February 20, 2023; Published: October 2023
Copyright: ©2023 Hussein-ElAhmed et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Husein Husein-ElAhmed MD, PhD, Dept. of Dermatology and Venereology, Hospital de Baza, Granada, Spain.
Phone: 0034605506589 FAX: 0034958023136 Email: huseinelahmed@hotmail.com




Introduction                                                             prevalence or assessment of comorbidity burden) were ex-
                                                                         cluded. Five databases (Pubmed, Scopus, Embase, Cochrane
Hidradenitis suppurativa (HS) is a chronic, inflammatory                 Library and clinicaltrial.gov) were searched. Two authors
and relapsing skin disease. Cumulative evidence has estab-               extracted independently the data of the studies.
lished an association between HS and certain cardiovascular
risk factors such as metabolic syndrome, diabetes, hypertri-
glyceridemia and obesity. However, whether HS is an inde-                Results
pendent risk factor for myocardial infarction (MI) remains
                                                                         The search retrieved 15 records. After applying the inclusion
controversial.
                                                                         criteria and removing duplicates, five records comprising
                                                                         58.494 HS patients and 4.010.171 matched controls were

Objectives                                                               finally analyzed. The complete flow chart of the literature
                                                                         search is depicted in Figure 1 and full references of the five
A systemic review and meta-analysis were conducted to ac-                included records are presented in the Supplementary File 1.
curately evaluate the association between HS and risk of MI.             The meta-analysis showed the relative risk of MI was simi-
Eligible records comprised case-control, cross-sectional and             lar among both cohorts: 1.00 (95%CI: 0.49-2.02, I2=97%;
cohort designs that compared rates of MI in HS to control                Figure 2). To test the robustness of the meta-analysis, the
groups. All studies without control groups (eg analysis of               combined results were recalculated by excluding one study



Research Letter | Dermatol Pract Concept. 2023;13(4):e2023201                                                                        1
Figure 1. Flow chart of data extraction and selection process throughout the databases.




Figure 2. Forest plot of myocardial infarction in hidradenitis suppurativa individuals.



per iteration. The exclusion of any single study did not alter          found a negative correlation between HS and MI. The trim
the overall pooled outcome.                                             and ﬁll sensitivity analysis did not change the general result,
                                                                        suggesting our outcome is not an artefact. Though analyses

Conclusions                                                             of hazard ratio were conducted independently of HS severity,
                                                                        this does not seem to affect the final result: Pinter et al ob-
MI is mainly attributed to atherosclerosis. Atherosclerosis is          served the cardiovascular risk of MI in HS patients is largely
a chronic inflammatory disease that shares precise pathways             attributed to smoking and not to HS-related processes such
with HS such as overexpression of the T helper cell (Th)1/              as chronic systemic inflammation [2]. In fact, these authors
(Th)17 [1]. Our work aggregates all available literature so             found matching for nicotine dependence reduced the risk of
far, and after pooling the largest cohort of HS patients, we            MI in HS subjects to almost levels of the control participants.



2                                                                            Research Letter | Dermatol Pract Concept. 2023;13(4):e2023201
Accordingly, other authors noticed smoking is more frequent       the comparability of hospital versus population controls has
in severe HS patients and smoking increased likelihood of         not been explored in detail in case-control studies for HS, it
suffering from more severe HS form [3,4]. Together, these         is feasible to assume the matched-controls from general pop-
data indicate any potential increased incidence of MI related     ulation are healthier than hospital controls, and thus, any
to severity of HS is driven more to the smoking habit rather      negative correlation is even more robust.
than the enhanced systemic inflammation in severe HS.                  On summary, the association between HS and MI is not
   Along this line, a recent meta-analysis addressing this        evident from current literature and has yet to be elucidated.
question have showed the odds ratio of MI of HS patients is       Further research is warranted to clarify as to whether the HS
similar to healthy controls, while the risk ratio from cohort     population have an increased trend of suffering from this
studies cannot be assessed accurately due to the high hetero-     major cardiovascular event.
geneity of the current evidence [5].
   In psoriasis which shares immunological characteristics
with HS, such as Th1/Th17 pathways and involvement of             References
TNF-alpha, a meta-analysis showed slight increased risk of
                                                                  1. Schlapbach C, Hänni T, Yawalkar N, Hunger RE. Expression
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                                                                       denitis suppurativa and major adverse cardiac events: A system-
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                                                                       tiva may not be associated with venous thromboembolia: Re-
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                                                                       sults from a large Danish cross-sectional study. J Dermatol
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general population instead of hospital controls, and although          PMID: 26522930.




Research Letter | Dermatol Pract Concept. 2023;13(4):e2023201                                                                        3
