Although children with atopic dermatitis (AD) may have a slightly increased risk for ischemic heart disease, high-quality evidence defining cardiovascular risk profiles in children with AD is still lacking, according to findings from a systematic review and meta-analysis published in The Journal of Investigative Dermatology.

Chronic inflammatory childhood conditions such as pediatric systemic lupus erythematosus, HIV, inflammatory bowel disease, and juvenile inflammatory arthritis are considered risk factors for increased cardiovascular risk. Given that AD is the most common chronic inflammatory skin disease in the world, and moderate to severe AD in adults has been linked to an increased risk for cardiovascular events, investigators sought to characterize the association between childhood AD and cardiovascular conditions and risks.

Using the Web of Science, EMBASE, CINAHL, and PubMed, the investigators searched the databases from inception through mid-July 2022 for observational studies exploring the association between children with AD (age, <18 years) and cardiovascular-related outcomes and risk factors. Patients were required to have at least 1 risk marker for cardiovascular disease (CVD) or evidence of CVD as an outcome.

Five outcomes were assessed: hypertension, lipid disorder, diabetes, ischemic heart disease, and stroke.

A total of 577,148 patients from 10 studies (3 cross-sectional, 3 longitudinal, 3 case-controlled, and 1 longitudinal and cross-sectional study) were included in the analysis. The trials were conducted in Europe (6), the United States (3), and South Korea (1). Eight of the 10 studies were conducted between 2009 and 2017. Patient numbers across the studies were unbalanced, with study populations ranging from fewer than 100 patients to nearly 295,000 patients. The most commonly reported cardiovascular risk factors in children with AD were lipid disorder (10 studies) and hypertension (6 studies). Stroke was evaluated in 2 studies.

In order to determine the caliber and strength of the evidence, 2 reviewers independently used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment, categorizing evidence as high, moderate, low, and very low.

The investigators found an association between AD in children and ischemic heart disease in 3 studies (odds ratio [OR] 1.68; 95% CI, 1.29-2.19). An association between AD and diabetes was found in 4 studies (OR, 1.31; 95% CI, 1.12-1.53). However, 2 studies that adjusted for potential confounders found that these associations did not persist (OR, 0.98; 95% CI, 0.35-2.75).

AD was associated with lipid disorders in 7 studies (OR, 1.24; 95% CI, 1.13-1.36; 95% prediction interval [PI], 0.95-1.61). However, there was very high heterogeneity (I²=96.7%, P <.001; and I²=98%, P <.001, respectively).

In 2 studies, AD was not associated with stroke (OR, 1.24; 95% CI, 0.94-1.62); and in 5 studies, AD was not associated with hypertension (OR, 1.15; 95% CI, 0.98-1.34; 95% PI, 0.81-1.62).

According to the GRADE assessments, the certainty of evidence was very low (hypertension, lipid disorder, and stroke outcomes) to low (ischemic heart disease and diabetes). Additionally, the studies lacked detail regarding important confounders, such as BMI and AD severity.

Limitations of this meta-analysis include the high degree of heterogeneity between study populations, variation in outcomes and inconsistent definitions of AD. There was also an under-representation of diverse ethnic groups.

The investigators concluded, “This study sheds light on the lack of high-quality evidence needed to define cardiovascular risk profiles in children with atopic dermatitis.” They added, “Future research that considers AD severity and confounders like BMI is needed to inform guidelines for cardiovascular health surveillance.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.