Patients With Vitiligo Show Lower Pulmonary Embolism and Peripheral Vascular Disease Risk, but Mortality Rises with Comorbidities

TripleP Studio/Adobe Stock

In a research letter published in the Australasian Journal of Dermatology, researchers outlined a study in which they explored the risk of myocardial infarction (MI), cerebrovascular accident (CVA), peripheral vascular disease (PVD), and pulmonary embolism (PE) in patients with vitiligo versus otherwise healthy controls.¹

According to Kridin et al, previous studies have linked vitiligo with dyslipidaemia, metabolic syndrome, and obesity, among others.² Additionally, factors such as significantly lower vitamin D and calcium levels, coupled with higher IL-17 and zinc levels, may make patients with vitiligo more prone to myocardial infarction.³ However, an understanding of vitiligo and its potential associations with cardiovascular diseases remains limited and occasionally controversial, they noted.

The study, utilizing data from Clalit Health Services in Israel, was designed as a retrospective cohort study. The study followed over 123,000 participants, including 20,851 patients with vitiligo and 102,475 matched controls.

The baseline characteristics revealed comparable age, sex, and ethnicity distributions between the 2 groups. Utilizing multivariate analyses, the study evaluated the incidence of major cardiovascular events, including MI, CVA, PVD, and PE among patients with vitiligo versus individuals without depigmentation.

As a result, the findings indicate that patients with vitiligo have a statistically similar risk of MI and CVA compared to controls. However, they exhibited a decreased risk of PVD and PE.

Stratified analyses based on sex and age further validated these associations. Additionally, male patients with vitiligo had a lower risk of PVD and PE compared to females, while younger patients (<32.4 years) showed a significant decrease in PVD risk.

Furthermore, the study investigated the impact of comorbidities on all-cause mortality among vitiligo patients. Results revealed that patients with vitiligo and comorbid CVA, PVD, or PE had a significantly elevated risk of mortality compared to those without these conditions.

However, the presence of MI did not confer an increased risk of mortality. Patients with vitiligo who had comorbid MI or CVA exhibited a lower mortality rate compared to controls with similar cardiovascular conditions.

While patients with vitiligo may have a decreased risk of certain cardiovascular events, the presence of comorbidities such as CVA, PVD, or PE significantly impacts their mortality risk, according to study authors. Moving forward, further research is warranted to explore these associations in diverse populations with different ethnic backgrounds, they noted.

"This study demonstrated that Israeli patients with vitiligo have a decreased risk of subsequent PE and PVD and a comparable risk of MI and CVA. Vitiligo patients with comorbid PE, CVA and PVD are at increased risk of all-cause mortality than vitiligo patients without these comorbidities," wrote Kridin et al. "Additional studies investigating these outcomes in other study populations originating from different ethnic backgrounds are necessary. Further research into the shared underlying pathophysiology of vitiligo and CVD is necessary. This epidemiological evidence may have significant implications for physicians managing patients with vitiligo."

References

1. Kridin K, Kafri N, Cohen AD. Is vitiligo associated with an increased risk of cardiovascular outcomes? Perceptions from a population-based study. Aust J Dermatol. March 25, 2024. Accessed April 1, 2024. https://doi.org/10.1111/ajd.14251
2. Lotti T, D'Erme AM. Vitiligo as a systemic disease. Clin Dermatol. 2014; 32(3): 430–434. Accessed April 1, 2024. https://doi.org/10.1016/j.clindermatol.2013.11.0
3. Ahmed Abdel Rahman SH, Hussein MS, Mansour AI. Are patients with vitiligo more prone to myocardial infarction?: A case-control study. J Clin Aesthet Dermatol. 2019;12(11):28-31. Accessed April 1, 2024.