Vitiligo Increases Heart Disease & Stroke Risk, Study Reveals

In a recent study published in the journal eBioMedicine, researchers from the United States of America (US) looked at the risk of cardiovascular disease (CVD) in vitiligo patients over 15 years. They discovered that people with vitiligo had a higher risk of CVD, including stroke and significant adverse cardiovascular events, than those without it.

Background
Vitiligo is a chronic skin illness that affects 0.5-2% of the world’s population and is defined by immune-mediated melanocyte death. Although vitiligo was once thought to be an esthetic issue, it is now recognized as a systemic syndrome associated with thyroid diseases, connective tissue disease, and other skin conditions such as psoriasis and alopecia areata.

Patients with vitiligo frequently have metabolic changes, such as insulin resistance and altered lipid profiles, which contribute to metabolic syndrome. Previous research on CVD risks in vitiligo patients have shown inconsistent results: some report raised CVD risk, while others show no significant increase or even lower mortality rates in Korean individuals.

However, new evaluations suggest a link between vitiligo and CVD risk factors similar to those found in chronic inflammatory skin illnesses such as psoriasis and systemic lupus erythematosus.

To fill this knowledge vacuum, researchers performed a retrospective analysis of a large-scale electronic health record (EHR) database in the United States to estimate CVD risk in vitiligo patients.

About the study
The data came from the TriNetX database, which contains deidentified EHRs from 57 healthcare organizations in the United States. Patients with a previous CVD diagnosis were eliminated. Two cohorts were formed. Patients with vitiligo were defined as having at least one ICD10 (International Classification of Diseases, 10th version) diagnosis of L80 (n = 100,047). Controls had at least one ICD10 Z00 diagnosis but no L80 diagnosis (n = 7,537,768).

To account for any potential bias, additional matching was performed using age, gender, and other health variables. Vitiligo patients had a mean age of 38.8 years, with 54.2% being female and 53.5% being white. Cardiovascular outcomes were tracked for 15 years after diagnosis, excluding individuals with pre-existing CVD diagnoses.

To balance the groups (n = 96,581 in each), a nearest-neighbor approach was used for propensity-score matching. Sensitivity analyses were performed to assess the results using different matching criteria and shorter follow-up periods.

CVD onset time was evaluated, with a median follow-up of around three years. The statistical analysis included the log-rank test, univariate Cox proportional hazards regression with proportional hazards assumption validation, Kaplan-Meier survival analysis, pairwise log-rank comparison, and Bonferroni correction.

Conclusion
In conclusion, the current study reveals that individuals with vitiligo may have a higher risk of developing CVD, emphasizing the importance of improved patient monitoring and preventative intervention. Further research is needed to determine a causal relationship between vitiligo and cardiovascular risk.

Furthermore, in the future, researchers could investigate the processes underlying this relationship and validate their findings in prospective clinical investigations.

For more information: Vitiligo is associated with an increased risk of cardiovascular diseases: a large-scale, propensity-matched, US-based retrospective study, eBioMedicine, doi:10.1016/j.ebiom.2024.105423