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Incidence of Myocardial Infarction and Cerebrovascular Accident in Patients With Hidradenitis Suppurativa

Educational Objective:
To discuss the associations of hidradenitis suppurativa with myocardial infarction and cerebrovascular accident.
1 Credit CME
Key Points

Question  Is hidradenitis suppurativa associated with an increased risk of myocardial infarction and cerebrovascular accident?

Findings  In this cohort study of 49 862 patients with hidradenitis suppurativa, significantly increased risk of myocardial infarction or cerebrovascular accident was noted among patients with hidradenitis suppurativa compared with controls. Increased risks were also noted for myocardial infarction alone and cerebrovascular accident alone.

Meaning  Hidradenitis suppurativa appears to be an independent risk factor for cardiovascular events, including myocardial infarction and cerebrovascular accident; patients with hidradenitis suppurativa may benefit from screening and early management of risk mediators.


Importance  Although hidradenitis suppurativa (HS) is associated with several cardiovascular risk mediators, information on the risk of myocardial infarction (MI) and cerebrovascular accident (CVA) in this population is sparse.

Objective  To compare risk of MI, CVA, and composite disease (MI or CVA) in patients with HS, stratified by use of biologic agents, with controls without HS.

Design, Setting, and Participants  A retrospective cohort analysis was conducted between January 1, 1999, and April 1, 2019, using a demographically heterogeneous population-based sample of over 56 million unique patients. Individuals with HS (n = 49 862) and without HS (n = 1 421 223) were identified using electronic health records data.

Main Outcomes and Measures  The primary outcome was incidence of composite MI or CVA.

Results  Of the 49 862 patients with HS, 37 981 were women (76.2%), 29 711 were white (59.6%), and mean (SD) age was 38.3 (13.3) years. Crude incidence rate of composite disease was 6.6 (95% CI, 6.3-7.0) per 1000 person-years in patients with HS compared with 6.8 (95% CI, 6.7-6.8) per 1000 person-years in controls. In patients with HS, crude incidence rates were 2.9 (95% CI, 2.6-3.1) per 1000 person-years for MI alone and 4.1 (95% CI, 3.9-4.4) per 1000 person-years for CVA alone compared with 3.2 (95% CI, 3.18-3.25) per 1000 person-years for MI alone in control patients and 4.1 (95% CI, 4.0-4.1) per 1000 person-years for CVA alone in control patients. In adjusted analysis, patients with HS had a 23% increased risk of composite disease (hazard ratio [HR], 1.23; 95% CI, 1.17-1.30; P < .001) and a similar increase in the risk of MI alone (HR, 1.21; 95% CI, 1.12-1.32; P < .001) and CVA alone (HR, 1.22; 95% CI, 1.14-1.31; P < .001) compared with control patients. The relative difference in composite MI or CVA risk between patients with HS and controls was highest among younger patients HR in subgroup aged 18-29 years: 1.67; 95% CI, 1.37-2.03).

Conclusions and Relevance  Patients with HS appear to have an increased risk of MI and CVA. Early management of modifiable cardiovascular risk mediators may be warranted in patients with HS.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: September 11, 2019.

Corresponding Author: Amit Garg, MD, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, Ste 300, New Hyde Park, NY, 11042 (amgarg@northwell.edu).

Published Online: November 13, 2019. doi:10.1001/jamadermatol.2019.3412

Author Contributions: Mr Strunk and Dr Garg had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Strunk, Garg.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Reddy, Garg.

Critical revision of the manuscript for important intellectual content: Strunk, Gregor, Garg.

Statistical analysis: Strunk, Garg.

Obtained funding: Garg.

Administrative, technical, or material support: Reddy.

Supervision: Garg.

Conflict of Interest Disclosures: Dr Gregor reported receiving grants from AbbVie, InflaRx, Janssen Pharma, and UCB; and personal fees from AbbVie, Chemocentryx, InflasRx, Incyte, and personal fees from UCB outside the submitted work. Dr Garg reported receiving grants and personal fees from AbbVie, personal fees from Amgen, Asana Biosciences, Pfizer, UCB, and Janssen during the conduct of the study. No other disclosures were reported.

Funding/ Support: This study was supported in part by an education grant from AbbVie.

Role of the Funder/Sponsor: AbbVie had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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