Skin calls to the heart: a common thread links the condition to the risk of arrhythmias and heart attacks

Hives that last for more than six weeks, with no apparent cause. This is accompanied by intermittent flare-ups and relapses that can even persist for months or years. Chronic spontaneous urticaria can manifest in this way in terms of skin lesions, with rashes that may appear and disappear repeatedly over hours or days, causing intense itching. However, focusing solely on the skin in people suffering from this condition may be an oversimplification.

There is, in fact, a factor that can link what may appear to be merely a ‘simple’ skin condition to other systems in the body, first and foremost the cardiovascular system. It is called inflammation. And it is precisely these systemic inflammatory processes that are thought to underlie the increased risk of arrhythmias and other cardiovascular events. This finding is reported in a study published in Allergy and conducted by Philip Curman, Diamant Thacj and Ralf J. Ludwig of the University of Lübeck. The study reveals a link between chronic spontaneous urticaria and cardiovascular risk, highlighting the need for preventive assessments of the circulatory system in people suffering from this skin condition.

Research shows that chronic spontaneous urticaria is associated with an increased risk of cardiovascular disease, particularly conduction disorders, due to its pro-inflammatory and pro-thrombotic nature. To reach this conclusion, the experts used data from the TriNetX database. They analysed 105,593 adult patients with chronic spontaneous urticaria and compared them with controls who did not have the skin condition but shared the same demographic characteristics and cardiovascular risk profile. The two groups were matched according to key demographic data and cardiovascular risk factors. The two groups were followed up for an average of around three years. What did the findings reveal? Essentially, there appear to be associations between the presence of chronic spontaneous urticaria and major cardiovascular events such as heart attacks or strokes, arrhythmias and cardiac conduction disorders, valvular heart disease and, to name a few other examples, the risk of venous thromboembolism or infections.

“The associations observed are biologically plausible,” the authors of the analysis note in their correspondence. Chronic spontaneous urticaria is characterised by chronic systemic inflammation, with elevated levels of C-reactive protein, interleukin-6 and tumour necrosis factor, all of which are factors linked to cardiovascular events and mortality.” As if that were not enough, it should be noted that the skin condition is often associated with conditions typical of metabolic syndrome, such as obesity, hypertension, diabetes and dyslipidaemia, which may further contribute to vascular damage.

“Inflammation is re-emerging as one of the main pathogenic mechanisms underlying numerous cardiovascular diseases,” comments Leonardo De Luca, Head of Cardiology at the Policlinico San Matteo in Pavia. “Studies such as this reinforce the idea that conditions apparently limited to a single organ, such as chronic spontaneous urticaria, may reflect a systemic inflammatory state with repercussions for the heart and blood vessels as well.” In short: we now know that inflammation is not merely a risk marker, but represents a genuine causal factor in atherosclerosis and its clinical manifestations. “This is why a comprehensive assessment of the patient and close collaboration between specialists are essential,” concludes De Luca. In this regard, research is opening up very promising therapeutic avenues: indeed, the results of major clinical trials on drugs capable of selectively targeting the inflammasome are expected in the coming years, with the aim of reducing the residual cardiovascular risk associated with inflammation.”