Vitiligo Linked to Higher Cardiovascular Disease Risk

Vitiligo, a skin condition causing depigmentation, may significantly increase the risk of serious cardiovascular events. | Image Credit: Liga Cerina - stock.adobe.com

Patients diagnosed with vitiligo demonstrated a greater risk of cardiovascular disease compared with individuals who did not have this dermatologic condition, according to a study published in eBioMedicine.1

Vitiligo is a skin disease that is known to destroy melanocytes and result from a complex pathogenesis that includes genetic factors, autoimmunity, oxidative stress, and neurochemical mediators. About 0.5% to 2% of the global population is affected by vitiligo.

Additional comorbidities often associated with vitiligo are psychological, neurological, endocrinological, hematologic, connective tissue, and gastrointestinal diseases.2 Ocular and auditory abnormalities, as well as other skin diseases and related disorders have been found to be associated with vitiligo.

Previous research has found vitiligo to affect organ function when the melanocyte destruction shares a common embryological origin. Insulin resistance and abnormalities in the lipid profile and metabolic syndrome are also related to vitiligo diagnosis.1

In the current study, a retrospective analysis of a large-scale, US based electronic health record (EHR) database examined patients with vitiligo to determine their cardiovascular risk. Data were collected from the US Collaborative Network, which consisted of 57 health care organizations and included about 96 million patients.

The study focused on 96,581 EHRs that covered patients with vitiligo, with more than half of the population being White female patients (53.5% and 54.2%, respectively). There were 94 cardiovascular diagnoses identified that were present in at least 1% of both cohorts. Of these 94 cardiovascular diseases, 54 had statistically significant increased risk among patients with vitiligo. None of the cardiovascular diseases that were investigated were linked to a reduced risk in patients with vitiligo.

An increased risk of cerebral infarction was among the highest for cerebrovascular disease based on an unspecified occlusion or stenosis of cerebral arteries (HR, 1.43; 95% CI, 1.24-1.64). Hypertensive chronic kidney disease had the highest mortality risk of the diseases that affect arteries, arterioles, and capillaries (HR, 1.52; 95% CI, 1.41-1.63). Among patients with heart valve diseases, rheumatic tricuspid insufficiency was most relevant (HR, 1.35; 95% CI, 1.19-1.53).

Most cardiovascular disease fell within the category of heart conduction (n = 22). An additional 6 cardiovascular disease groups were found, and these were heart failure, cardiomyopathy, ischemic heart diseases, angina pectoris, old myocardial infarction, and acute myocardial infarction. A majority of diagnoses were discovered 2.95 years prior in patients with vitiligo compared with controls. The average total years to diagnosis were 7.92 for individuals with vitiligo and 10.77 for the controls.

Study results show patients with vitiligo demonstrate an increased risk of developing cardiovascular diseases like cerebral infarction, acute myocardial infarction, pulmonary embolism, and venous thrombosis. The overall risk of major adverse cardiovascular events was higher as well.

This retrospective study, relying on potentially error-prone EHRs, may have limitations. Data gaps include critical clinical information like scores, disease duration, specific treatments, and detailed severity/activity/subtype. Analysis should be cautious due to potential misdiagnosis, imprecise reporting, and time-dependent HR changes. Built-in selection bias is possible, and some findings may not be statistically significant after multiple comparisons. Results also may show associations, but evidence weakens after accounting for multiple comparisons.

A previous study found vitiligo was associated with obesity, dyslipidemia, hypertension, lifestyle such as drinking or smoking habits, homocysteine and C-reactive protein levels, and hyperglycemia.3 Future studies could focus more on lifestyle factors linked to an increased risk for the development of cardiovascular diseases among patients with vitiligo.

“This large-scale study indicates that patients with vitiligo seem to be at an increased risk for the development of cardiovascular diseases, which may give clinicians beneficial insights for patient monitoring and prophylaxis management,” concluded study authors.1

References

1. Frączek A, Owczarczyk-Saczonek A, Ludwig RJ, et al. Vitiligo is associated with an increased risk of cardiovascular diseases: a large-scale, propensity-matched, US-based retrospective study. EBioMedicine. 2024;109:105423. doi:10.1016/j.ebiom.2024.105423

2. Hu Z, Wang T. Beyond skin white spots: vitiligo and associated comorbidities. Front Med (Lausanne). 2023;10:1072837. doi:10.3389/fmed.2023.1072837

3. Liang X, Guo F, Zhang M, et al. Risk factors for cardiovascular diseases in patients with vitiligo: an analysis of current evidence. Ann Med. 2024;56(1):2326297. doi:10.1080/07853890.2024.2326297