Bullous pemphigoid tied to increased risk of CVD, all-cause mortality: JAMA
Taiwan: Findings from a recent study in the journal JAMA Dermatology suggest that patients with bullous pemphigoid (BP) are at a 5-fold increased risk of CVD mortality. This was seen particularly in patients without underlying cardiovascular disease (CVD) or hypertension or those without prior corticosteroid or diuretic use.
The role of bullous pemphigoid in CVD mortality remains controversial and there is a dearth of data on the analyses of causes of death among patients with BP based on individual data. Considering this, Wan-Chieh Shen, Department of Dermatology, China Medical University Hospital, Taichung City, Taiwan, and colleagues aimed to evaluate the risk of all-cause mortality, CVD mortality, and cancer mortality in patients with BP in a cohort study.
The study identified patients with a diagnosis of and treatment for BP at a tertiary medical center in central Taiwan between January 1, 2007, and December 31, 2017. Patients without BP were controls and were individually matched to cases in the ratio of 4:1 according to age, sex, and date of the dermatology clinic visit. Data analysis was done from March 6, 2019, to April 2, 2021. Of 252 patients with BP and 1008 matched control patients (N = 1260), 685 (54.4%) were men and the median age was 78.0 years.
Using typical direct immunofluorescence findings or clinically with typical clinical presentation, positive findings of an anti–basement membrane zone antibody test, and corticosteroid use for at least 28 cumulative days, the researchers confirmed the pathological presence of bullous pemphigoid.
The main outcome measure was mortality outcomes confirmed by the National Death Registry.
Following were the study's key findings:
- Patients with BP had higher CVD mortality at 1 year (7.9% vs 13 1.3%), 3 years (11.1% vs 2.4%), and 5 years (12.3% vs 39 3.9%) compared with matched control patients.
- After adjusting for potential confounding variables, patients with BP had a 5-fold higher risk of CVD mortality at 1 year (hazard ratio [HR], 5.29), 3 years (HR, 5.79), and 5 years (HR, 4.95).
- Subgroup analyses revealed that the CVD mortality risk associated with BP was higher in patients without a history of hypertension (HR, 7.28) or CVD (HR, 6.59) and in patients without prior diuretic use (HR, 5.75) compared with matched control patients.
- In addition, all-cause mortality associated with BP was higher in patients without prior corticosteroid use than in control patients (HR 5.65).
"Our findings suggest that BP is associated with a 5-fold higher risk of CVD mortality, particularly in patients without underlying hypertension or CVD or those without prior corticosteroid or diuretic use," the authors wrote.
"Future studies should investigate the benefits of routine monitoring and timely management of CVD symptoms and signs in patients with BP," they concluded.
Reference:
Shen W, Chiang H, Chen P, Lin Y, Kuo C, Wu P. Risk of All-Cause Mortality, Cardiovascular Disease Mortality, and Cancer Mortality in Patients With Bullous Pemphigoid. JAMA Dermatol. Published online December 29, 2021. doi:10.1001/jamadermatol.2021.5125
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