Hidradenitis suppurativa was associated with 1.3- to 1.8-fold cardiovascular risk

Design

Systematic review and random-effects meta-analysis of observational studies, GRADE

Population

373,689 people with HS across 25 studies

Primary outcome

Cardiovascular comorbidity prevalence and risk vs people without HS

Effect

Relative risks about 1.3-1.8 for CHD, MI, heart failure, VTE and death; low certainty

A systematic review and meta-analysis pooled 25 studies covering 373,689 people with clinician-diagnosed hidradenitis suppurativa (HS), with GRADE assessment.

Hypertension affected about a quarter of patients. Compared with people without HS, HS was associated with relative risks generally between 1.3 and 1.8 for ischaemic heart disease, composite cardiovascular disease, myocardial infarction, heart failure, venous thromboembolism and all-cause mortality. Results were directionally consistent in sensitivity analyses, but heterogeneity was substantial and certainty was low.

HS patients are often young, and cardiovascular risk is rarely on the agenda at a dermatology visit. The pattern here resembles what is already accepted for psoriasis.

The practical step is not new treatment but making sure someone checks blood pressure, lipids, glucose, weight and smoking.

• Measure blood pressure at HS reviews.
• Ask about smoking and offer cessation support; it drives both HS and cardiovascular risk.
• Check lipids, HbA1c and BMI, or confirm the GP has.
• Include cardiovascular risk in the letter back to primary care.

Why it matters

Cardiovascular risk in young HS patients is easy to miss when every visit is focused on the skin.

Don't overread it

The studies were observational with inconsistent adjustment for smoking and obesity, so HS itself has not been shown to cause the risk.

The statistics, in plain English

Relative risks of 1.3 to 1.8 mean 30% to 80% higher rates, but low certainty means the true figures could differ substantially. Much of the excess may be explained by smoking and obesity, which are common in HS and not always fully adjusted for.

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