Cardiovascular risk among middle-aged Japanese adults with atopic dermatitis: A nested case–control study

Background and objective: The increasing prevalence of atopic dermatitis (AD) has raised concerns about whether individuals with AD require specific cardiovascular disease (CVD) prevention strategies. This study investigated the association between AD and CVD among middle-aged adults. Methods: We conducted a nested case–control study using data from the Kyoto Claim Database (April 2013–March 2023) among individuals aged 40–59 years who were followed for ≥ 3 years. Cases were patients with first-onset CVD (hospitalization for ischemic heart disease or stroke), whereas controls had no history of CVD. AD was defined by an ICD-10 code (L20) plus a topical corticosteroid (TCS) prescription. For each case, 10 controls were matched on age, sex, index month, hypertension, diabetes, dyslipidemia, hyperuricemia, and use of anticoagulant or antiplatelet agents. Logistic regression was used to assess associations between CVD and AD prevalence or severity. Results: We identified 2,757 CVD cases, including 1,247 with ischemic heart disease and 1,563 with stroke (median age 53 years [interquartile range, 49–56]; 2,031 [73.7%] male). Comorbidities included hypertension in 1,430 (51.9%), diabetes in 583 (21.1%), dyslipidemia in 1,018 (36.9%), hyperuricemia in 307 (11.1%), and anticoagulant or antiplatelet prescriptions in 377 (13.7%). The median follow-up period was 60 months. After matching, 2,672 cases and 26,720 controls were compared. AD was diagnosed in 66 cases (2.5%) and 728 controls (2.7%), with no significant association between AD and CVD (odds ratio [OR], 0.90; 95% confidence interval, 0.69–1.16). Regarding AD severity, 3 cases (0.1%) and 76 controls (0.3%) were in the top 10% of average monthly TCS dose (≥37.8 g/month); 28 cases (1.0%) and 352 controls (1.3%) received class 1 TCS; and 14 cases (0.5%) and 144 controls (0.5%) received systemic treatment (immunosuppressants or biologics). AD severity was not associated with CVD risk (ORs: 0.39 [0.10–1.05], 0.79 [0.53–1.15], and 0.97 [0.53–1.62], respectively). A limitation of this study was potential misclassification of AD status due to the nature of claims data. Conclusion: Among adults aged 40–59 years, AD was not significantly associated with an increased risk of CVD onset, even in severe cases. Targeted CVD screening for patients with AD may not be necessary; however, comprehensive management of standard CVD risk factors remains essential, as in the general population.