Lack of association between vitiligo and major adverse cardiovascular events: A population-based cohort study

TY - JOUR

T1 - Lack of association between vitiligo and major adverse cardiovascular events

T2 - A population-based cohort study

AU - Wu, Po Chien

AU - Ma, Sheng Hsiang

AU - Wu, Chun Ying

AU - Pan, Tzu Yun

AU - Chang, Yun Ting

AU - Wu, Chen Yi

N1 - Funding Information: This study was funded by grants from the Ministry of Science and Technology, Taiwan, R.O.C. (MOST 108-2314-B-075-041-MY3) and Taipei Veterans General Hospital (V111C-022). Vitiligo is a common skin depigmentation disorder drawing disturbances in quality of life and psychological concerns.1 Several mechanisms have been postulated for the development of vitiligo, including T cell-mediated inflammation, oxidative stress impairment and generation of pro-inflammatory cytokines, which may be associated with the risk of major adverse cardiovascular events (MACE).2,3 Studies have explored the relationship between MACE and other skin inflammatory conditions such as psoriasis, atopic dermatitis and alopecia areata,4–6 but the association between vitiligo and MACE remains obscure. Therefore, we conducted this population-based cohort study to investigate this issue. Based on Taiwan's National Health Insurance Research Database between 2007 and 2018, this study was performed in accordance with the Declaration of Helsinki and approved by the National Health Research Institute and the Institutional Review Board of Taipei Veterans General Hospital, Taipei, Taiwan (IRB:2020-06-016BC). All patients diagnosed with vitiligo (ICD-9-CM code 709.01; ICD-10-CM code L80) more than three times in an outpatient department or once in hospitalization by dermatologists were eligible for inclusion. We identified MACE with diagnostic codes of cardiovascular events, including acute myocardial infarction and ischemic heart disease, and cerebrovascular events, including ischemic stroke and haemorrhagic stroke. Certain factors such as age, sex and comorbidities used in propensity-score matching were considered as potential confounders. Comorbidities included hypertension, diabetes mellitus, hyperlipidaemia, renal disease, chronic liver disease, cirrhosis, chronic obstructive pulmonary disease, psychiatric diseases including schizophrenia, autoimmune connective tissue disease and autoimmune thyroid disease and cancer. Other possible risk factors for MACE, such as number of hospital visits, income, phototherapy and vitiligo medications were also analysed. The cumulative incidence and Cox proportional hazards models were used to investigate the risk of MACE. A total of 19,643 patients with vitiligo and 78,572 matched controls were enrolled. Figure 1 presents the cumulative incidence rate of MACE, which showed no significant difference between the vitiligo and non-vitiligo cohorts in 5 years (2.75%; 95% confidence interval [CI], 2.49–3.01 for vitiligo vs. 2.41%; 95% CI, 2.29–2.53 for control, p = 0.08). Table 1 presents the risk factors associated with MACE during the 5-year follow-up period. After adjusting for age, sex, number of hospital visits, income and comorbidities, the association between vitiligo and MACE revealed no significant difference (HR, 1.05; 95% CI, 0.94–1.17; p = 0.37). No significant differences were found between vitiligo and MACE in patients with different subgroups. Abbreviations: CI, confidence interval; HR, hazard ratio; MACE, major adverse cardiovascular events. Adjusted for age, sex, hospital visit number, income, hypertension, diabetes mellitus, hyperlipidaemia, renal disease, chronic liver disease and cirrhosis, chronic obstructive pulmonary disease, psychiatric diseases including schizophrenia, autoimmune connective tissue disease, autoimmune thyroid disease and cancer. To our knowledge, this is the first study to include a large cohort of Asian patients with vitiligo to assess the risk of MACE. Vitiligo has a controversial relationship with cardiovascular risk factors. Greater risks of developing atherosclerosis, metabolic syndrome, dyslipidaemia and myocardial infarction were observed.3,7,8 On the contrary, other evidence found a better lipid profile among vitiligo patients than controls.2,9 There were no consistent findings about the association between vitiligo and cardiovascular risk factors. In addition, a causal relationship required a dose–response effect and plausible pathogenesis, which was not provided in previous literature. Multiple comorbidities, such as hypertension, diabetes mellitus and hyperlipidaemia,10 are well-known risk factors for MACE. To scrutinize the exact effect of vitiligo on the following MACE, we chose the control group by propensity score-matched comorbidities, which was a major advantage over former case–control studies. We provided solid epidemiological evidence for the lack of association between vitiligo and MACE. Limitations of this study included misclassification bias, uncontrolled comorbidities of vitiligo and MACE, and the concern of external validity in non-Asian ethnicities. In conclusion, our study suggests no significant association between vitiligo and the risk of MACE. No significant differences were found between vitiligo and MACE in patients with different age groups, sex and multiple comorbidities. Funding Information: This study was funded by grants from the Ministry of Science and Technology, Taiwan, R.O.C. (MOST 108‐2314‐B‐075‐041‐MY3) and Taipei Veterans General Hospital (V111C‐022).

PY - 2023/6

Y1 - 2023/6

UR - http://www.scopus.com/inward/record.url?scp=85147990711&partnerID=8YFLogxK

U2 - 10.1111/jdv.18936

DO - 10.1111/jdv.18936

M3 - Letter

C2 - 36734285

AN - SCOPUS:85147990711

SN - 0926-9959

VL - 37

SP - e773-e775

JO - Journal of the European Academy of Dermatology and Venereology

JF - Journal of the European Academy of Dermatology and Venereology

IS - 6

ER -