Vitiligo linked to increased risk of heart disease and stroke, study finds

By Dr. Sushama R. Chaphalkar, PhD.Reviewed by Lily Ramsey, LLMOct 29 2024

New study reveals higher cardiovascular risk in vitiligo patients, underscoring need for proactive care.

Study: Vitiligo is associated with an increased risk of cardiovascular diseases: a large-scale, propensity-matched, US-based retrospective study. Image Credit: Awishka215/Shutterstock.com

In a recent study published in the journal eBioMedicine, researchers from the United States of America (US) investigated the risk of cardiovascular disease (CVD) in patients with vitiligo over 15 years. They found that patients with vitiligo had an increased CVD risk, including stroke and major adverse cardiovascular events, compared to those without vitiligo.

Background

Vitiligo is a chronic skin disease affecting about 0.5–2% of the global population, characterized by immune-mediated destruction of melanocytes. Although it was traditionally viewed as an esthetic issue, vitiligo is increasingly being recognized as a systemic condition linked to various comorbidities like thyroid disorders, connective tissue disease, and other skin conditions, including psoriasis and alopecia areata.

Patients with vitiligo often exhibit metabolic disturbances, such as insulin resistance and abnormal lipid profiles, contributing to metabolic syndrome. Previous studies on CVD risks in vitiligo patients have yielded conflicting results: some report elevated CVD risk, while others show no significant increase or even lower mortality rates in Korean patients.

However, recent reviews support an association between vitiligo and CVD risk factors similar to those observed in chronic inflammatory skin diseases like psoriasis and systemic lupus erythematosus.

To address this knowledge gap, researchers conducted a retrospective analysis using a large-scale electronic health record (EHR) database in the US to assess CVD risk in patients with vitiligo.

About the study

Data were obtained from the TriNetX database, which includes deidentified EHRs from 57 US-based healthcare organizations. Patients with prior CVD diagnoses were excluded. Two cohorts were formed. Patients with vitiligo were identified as those with at least one ICD10 (short for International Classification of Diseases, 10^th revision) diagnosis of L80 (n = 100,047). Controls had at least one ICD10 diagnosis of Z00 without any diagnosis of L80 (n = 7,537,768).

Further matching was conducted by age, sex, and other health factors to address any potential bias. Patients with vitiligo had a mean age of 38.8 years; 54.2% of them were female, and 53.5% were White. Cardiovascular outcomes within 15 years post-diagnosis were tracked, excluding patients with preexisting CVD diagnoses.

Propensity-score matching was performed to balance the groups (n = 96,581 in each group) using a nearest-neighbor algorithm. Sensitivity analyses were conducted to test the results under alternative matching criteria and shorter follow-up periods.

CVD onset time was assessed, with a median follow-up of about three years. Statistical analysis involved a log-rank test, univariate Cox proportional hazards regression with proportional hazards assumption validation, Kaplan–Meier survival analysis, pairwise log-rank comparison, and Bonferroni correction.

Results and discussion

Overweight/obesity was observed in 8.8%, and nicotine dependence/history was reported in 6.6% of the cases. A total of 94 cardiovascular diagnoses were observed with increased frequency in vitiligo, categorized into ten cardiovascular groups, including cardiomyopathies, cerebrovascular diseases, arterial and venous disorders, heart valve diseases, heart failure, ischemic heart diseases, and conduction disorders.

Of these, 54 diagnoses showed significantly increased risk, particularly in conditions like sick sinus syndrome (hazard ratio [HR] 1.58), hypertensive chronic kidney disease (HR 1.52), other pericardial diseases (HR 1.50), acute on chronic systolic (congestive) heart failure (HR 1.48), and acute embolism and thrombosis of unspecified deep veins of unspecified lower extremities (HR = 1.47).

A total of 4,028 patients with vitiligo had a diagnosis of major adverse cardiovascular events (MACE), compared to 3,042 among controls. A higher risk of MACE was found in vitiligo patients (HR 1.28), persisting across sensitivity analyses. Within cerebrovascular diseases, the risks for cerebral infarction and its sequelae were found to be particularly higher.

In arterial and capillary diseases, the risk was highest for hypertensive heart and kidney diseases. Heart valve and conduction disorders also saw higher risk, particularly for mitral valve disorders and various types of arrhythmias. Interestingly, vitiligo patients experienced an earlier onset of cardiovascular events, averaging 2.95 years earlier than controls.

Specific conditions demonstrated even more pronounced differences. For example, sick sinus syndrome appeared about 5.5 years earlier in vitiligo patients. This accelerated onset highlights a potential need for earlier CVD screening and proactive management in vitiligo patients.

Although the study is strengthened by its large scale, it is limited by its retrospective EHR-based design, potential coding errors, lack of detailed clinical data on vitiligo, low-prevalence outcomes, time-dependent HR changes, selection bias, and HIPAA restrictions limiting detailed analysis.

Conclusion

In conclusion, the present study suggests that patients with vitiligo may have a higher risk of developing CVD, highlighting the need for enhanced patient monitoring and preventive care. Further research is required to establish a causal link between vitiligo and cardiovascular risk.

Additionally, in the future, researchers could potentially explore the mechanisms underlying this association and verify these findings in prospective clinical studies.