Cardiovascular Risk in Hidradenitis Suppurativa

Key Takeaways

• Pooled associations favored higher risks for ischemic or coronary heart disease, composite cardiovascular disease, myocardial infarction, heart failure, venous thromboembolism, and all-cause mortality.
• Hypertension was the most frequently reported cardiovascular comorbidity and affected approximately one-quarter of patients with hidradenitis suppurativa.
• The authors described the evidence as limited and observational, and said the findings support consideration of cardiovascular risk assessment in hidradenitis suppurativa management.

In a systematic review and meta-analysis in the British Journal of Dermatology, hidradenitis suppurativa was associated with increased risk across multiple cardiovascular outcomes compared with individuals without hidradenitis suppurativa, with relative risks generally ranging from 1.3- to 1.8-fold. The increased risks spanned ischemic or coronary heart disease, composite cardiovascular disease, myocardial infarction, heart failure, venous thromboembolism, and all-cause mortality in pooled analyses.

The review synthesized evidence across several major endpoints rather than a single vascular diagnosis. These associations came from pooled observational studies rather than research designed to establish causation directly. Overall, the findings pointed to a broad cardiovascular burden signal rather than an isolated increase in any single vascular outcome.

The review followed PRISMA 2020 and searched the CINAHL, Cochrane, Embase, PubMed, and Scopus databases from inception through 16 June 2025. Eligible studies included clinician-diagnosed hidradenitis suppurativa identified through medical records, diagnostic codes, or direct physician assessment. For association analyses, investigators required studies to compare participants with hidradenitis suppurativa against people without hidradenitis suppurativa. Across 25 studies, 373,689 individuals with hidradenitis suppurativa were included, with 24 studies contributing prevalence data and 17 providing association estimates. The investigators preferentially used the most adjusted estimate available, creating a framework to examine both comorbidity burden and comparative cardiovascular outcomes.

Pooled analyses showed modest-to-moderate elevations in ischemic or coronary heart disease, composite cardiovascular disease, myocardial infarction, heart failure, venous thromboembolism, and all-cause mortality. The directional pattern favored higher cardiovascular risk in hidradenitis suppurativa across each of these major outcomes. These pooled comparisons were separate from prevalence estimates reported within hidradenitis suppurativa cohorts.

Among cardiovascular comorbidities assessed within hidradenitis suppurativa cohorts, reported conditions also included coronary artery disease, cerebrovascular disease, congestive heart failure, and myocardial infarction. Overall, the outcome profile suggested a signal extending across arterial, venous, and mortality endpoints rather than one major category alone.

Sensitivity analyses showed the same directional pattern across outcomes, even as pooled estimates varied meaningfully across studies. The investigators reported substantial heterogeneity across most analyses and rated the overall certainty of evidence as low.

The authors said the findings support consideration of cardiovascular risk assessment in clinical management of hidradenitis suppurativa. They also called for prospective studies using standardized cardiovascular outcome definitions and more consistent adjustment for key confounders.