Patients With Vitiligo Have Decreased Risk of Subsequent Pulmonary Embolism, Peripheral Vascular Disease

Patients with vitiligo exhibited a decreased risk of subsequent pulmonary embolism (PE) and peripheral vascular disease (PVD) with a comparable risk of myocardial infarction (MI) and cerebrovascular accident (CVA) versus otherwise healthy controls in a recent study, according to a research letter published in the Australasian Journal of Dermatology.¹

Furthermore, individuals with vitiligo and comorbid PE, CVA, and PVD also demonstrated an increased risk of all-cause mortality than individuals without such comorbidities.

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Background and Methods

According to authors Kridin et al, the risk of cardiovascular disease among individuals with vitiligo has not been fully determined. Previous research has explored the associations between vitiligo and other conditions such as dyslipidemia, metabolic syndrome, and obesity, for example.²

A study published in the European Medical Journal last year assessed the relationship between vitiligo and cardiovascular disease risk factors.³ To the knowledge of its authors, it was the first known study to systematically review and assess the potential associations between vitiligo and cardiovascular disease risk and associated factors. Results were conflicting, with some reviewed literature pointing toward significant associations/increased risks and others indicative of a lowered risk of cardiovascular disease among individuals with vitiligo.

Researchers therefore conducted a population-based, retrospective cohort study of patients with vitiligo in Israel. They used longitudinal following to evaluate the incidence of cardiovascular concerns (PE, PVD, MI, and CVA) from data stored in Clalit Health Services' database.

In total, 123,326 patients were included in the study, of whom 20,851 had been diagnosed with vitiligo. The remaining individuals in the study were controls matched by age, ethnicity, and sex.

Findings

Among patients with vitiligo, researchers established hazard ratios for unadjusted risk, sex and age- stratified risk, and multivariate adjusted risk.

Regarding unadjusted risk, researchers calculated a hazard ratio of 0.67 (0.53–0.87) for PVD and a ratio of 0.57 (0.38–0.87) for PE among patients with vitiligo.

Furthermore, male-specific risk of PE yielded a hazard ratio of 0.75 (0.56–0.99), while PVD exhibited a ratio of 0.41 (0.20–0.84). Female-specific risk only of PE was noted as significant, with a ratio of 0.48 (0.28–0.84).

Specific to age, significant hazard ratios were noted among individuals with vitiligo who were aged 32.4 years and older, with a PE ratio of 0.68 (0.53–0.87) and a PVD ratio of 0.59 (0.39–0.89).

In the multivariate analysis, age and sex- adjusted risk exhibited significant ratios for both PE [0.63 (0.49–0.81)] and PVD [0.54 (0.36–0.81)]. The same held true in fully-adjusted risk regarding significant ratios for PE [0.69 (0.53–0.89)] and PVD [0.55 (0.36–0.86)].

CVA, PVD, or PE had a significantly higher risk of mortality compared to those without these conditions. However, the presence of MI did not increase the risk of mortality.

Additionally, patients with vitiligo who had comorbid MI or CVA had a lower mortality rate compared to controls with the same cardiovascular conditions. Conversely, the mortality rate of vitiligo patients with PVD or PE was similar to that of controls with these conditions.

Conclusions

No limitations of the study were noted by authors of the research letter, who presented their findings and concluded with a call for additional research of a similar nature.

"Additional studies investigating these outcomes in other study populations originating from different ethnic backgrounds are necessary," according to Kridin et al. "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. Australas J Dermatol. e March 25, 2024. Accessed May 6, 2024. doi:10.1111/ajd.14251
2. Lotti T, D'Erme AM. Vitiligo as a systemic disease. Clin Dermatol. 2014; 32(3): 430–434. https://doi.org/10.1016/j.clindermatol.2013.11.0
3. Rahman SM, Wang M, Ahmed F, Jafferany M. Assessing the relationship between vitiligo and cardiovascular disease risk factors. Eur Med J. September 5, 2023. DOI:10.33590/emj/10308019