Carotid ultrasound may improve CVD risk assessment in patients with inflammatory skin condition

Carotid ultrasound improves the cardiovascular risk stratification of individuals with the skin condition hidradenitis suppurativa (HS), according to a study published Jan. 4 in PLOS One.

HS is a chronic inflammatory condition that affects 1 to 4 percent of the general population and has been associated with an increased risk of adverse cardiovascular outcomes, lead author Marcos Antonio Gonzalez-Lopez, MD, PhD, and colleagues noted. Their research group has previously reported a greater prevalence of subclinical atherosclerosis in these patients.

“These observations suggest that HS itself may be an independent risk factor for atherosclerotic (cardiovascular) disease, and support the hypothesis that, as well as in other chronic inflammatory conditions, the persistent systemic inflammation may be crucial to explain the premature and accelerated atherogenesis in this disorder,” they wrote.

To test for atherosclerotic plaques, the researchers performed carotid ultrasound on 60 HS patients without a history of cardiovascular events, diabetes or chronic kidney disease. They also assessed each patient’s risk for CVD based on the Framingham Risk Score (FRS), a widely used predictive tool.

Forty percent of the patients were classified as low-risk based on the FRS, while 46.7 percent were intermediate risk and 13.3 percent high risk. However, the ultrasound revealed 32.6 percent of the patients classified as low or intermediate risk had carotid plaques, therefore bumping them up to the high-risk category.

“We feel that the use of non-invasive imaging techniques to disclose the presence of subclinical atherosclerosis may complement currently used risk assessment tools,” Gonzalez-Lopez and colleagues wrote. “An adequate stratification of HS patients would provide a more tight CV disease risk factor control in a clinically relevant proportion of these patients that are included in the categories of low and intermediate estimated CV disease risk according to FRS.”

The researchers acknowledged their small sample size may limit the impact of their findings. Also, they said additional research is needed to determine whether a reclassification to a higher risk category actually leads to more adverse cardiovascular events.

“Based on our data, we recommended the use of carotid (ultrasound) in HS-patients with an intermediate risk for cardiovascular disease,” Gonzalez-Lopez et al. wrote. “Low-risk HS individuals aged 50 years and older, active smokers, with severe or longstanding disease (>20 years) should be considered for carotid ultrasonography assessment according to an individualized clinical evaluation.”