Incidence of Myocardial Infarction and Cerebrovascular Accident in Patients With Hidradenitis Suppurativa

This cohort study compares the risk of myocardial infarction, cerebrovascular accident, and composite disease in patients with hidradenitis suppurativa. Importance Although hidradenitis suppurativa (HS) is associated with several cardiovascular risk mediators, information on the risk of myocardial infarction (MI) and cerebrovascular accident (CVA) in this population is sparse. Objective To compare risk of MI, CVA, and composite disease (MI or CVA) in patients with HS, stratified by use of biologic agents, with controls without HS. Design, Setting, and Participants A retrospective cohort analysis was conducted between January 1, 1999, and April 1, 2019, using a demographically heterogeneous population-based sample of over 56 million unique patients. Individuals with HS (n = 49862) and without HS (n = 1421223) were identified using electronic health records data. Main Outcomes and Measures The primary outcome was incidence of composite MI or CVA. Results Of the 49862 patients with HS, 37981 were women (76.2%), 29711 were white (59.6%), and mean (SD) age was 38.3 (13.3) years. Crude incidence rate of composite disease was 6.6 (95% CI, 6.3-7.0) per 1000 person-years in patients with HS compared with 6.8 (95% CI, 6.7-6.8) per 1000 person-years in controls. In patients with HS, crude incidence rates were 2.9 (95% CI, 2.6-3.1) per 1000 person-years for MI alone and 4.1 (95% CI, 3.9-4.4) per 1000 person-years for CVA alone compared with 3.2 (95% CI, 3.18-3.25) per 1000 person-years for MI alone in control patients and 4.1 (95% CI, 4.0-4.1) per 1000 person-years for CVA alone in control patients. In adjusted analysis, patients with HS had a 23% increased risk of composite disease (hazard ratio [HR], 1.23; 95% CI, 1.17-1.30; P < .001) and a similar increase in the risk of MI alone (HR, 1.21; 95% CI, 1.12-1.32; P < .001) and CVA alone (HR, 1.22; 95% CI, 1.14-1.31; P < .001) compared with control patients. The relative difference in composite MI or CVA risk between patients with HS and controls was highest among younger patients HR in subgroup aged 18-29 years: 1.67; 95% CI, 1.37-2.03). Conclusions and Relevance Patients with HS appear to have an increased risk of MI and CVA. Early management of modifiable cardiovascular risk mediators may be warranted in patients with HS. Question Is hidradenitis suppurativa associated with an increased risk of myocardial infarction and cerebrovascular accident? Findings In this cohort study of 49862 patients with hidradenitis suppurativa, significantly increased risk of myocardial infarction or cerebrovascular accident was noted among patients with hidradenitis suppurativa compared with controls. Increased risks were also noted for myocardial infarction alone and cerebrovascular accident alone. Meaning Hidradenitis suppurativa appears to be an independent risk factor for cardiovascular events, including myocardial infarction and cerebrovascular accident; patients with hidradenitis suppurativa may benefit from screening and early management of risk mediators.