Rosacea linked to hypertension, dyslipidaemia

Rosacea, a chronic inflammatory cutaneous disorder associated with multiple systemic illnesses, is associated with hypertension and dyslipidaemia but not with ischaemic heart disease (IHD), stroke, or diabetes, results of a systematic review and meta-analysis have shown.

“We advocate screening for cardiometabolic disease (CMD) indicators among patients with rosacea, which may be helpful for diagnosis and appropriate treatment at an early stage of disease,” the researchers said.

The databases of PubMed, Embase, Cochrane Library, and Web of Science were comprehensively searched for studies published before 16 October 2019. The pooled risk ratios (RRs) or standardized mean differences (SMD) were calculated.

Thirteen studies met the eligibility criteria, including 50,442 patients with rosacea. A statistically significant association was observed for hypertension (RR, 1.20, 95 percent confidence interval [CI], 1.08–1.34; p=0.001) and dyslipidaemia (RR, 1.32, 95 percent CI, 1.10–1.58; p=0.002) in patients with rosacea. [J Am Acad Dermatol 2020;83:1331-1340]

Rosacea also correlated with higher total cholesterol (SMD, 0.42, 95 percent CI, 0.17–0.68; p=0.001), higher low-density lipoprotein (SMD, 0.37, 95 percent CI, 0.18–0.56; p<0.001), higher triglycerides (SMD, 0.28, 95 percent CI, 0.08–0.49; p=0.006), higher systolic (SMD, 0.40, 95 percent CI, 0.19–0.62; p=0.000) and diastolic blood pressure (SMD, 0.50, 95 percent CI, 0.19–0.81; p=0.002).

On the other hand, rosacea did not correlate with IHD, stroke, diabetes, and high-density lipoprotein.

“Research has supplied ample evidence that activation of the sympathetic nervous system and vascular changes caused by transient receptor potential ion channels might contribute to the development of hypertension,” the researchers said. [J Exp Med 2018;215:21-33; Cardiovasc Res 2018;114:529-539]

Additionally, although beta-blockers, diuretics, and calcium-channel blockers (CCBs) have been proven effective against hypertension, prior studies indicated that they could either aggravate or alleviate symptoms of rosacea.

“CCBs are generally not recommended for patients with rosacea, especially those presenting with symptoms of flushing, whereas carvedilol and spironolactone prescriptions were suggested as primary options for patients displaying rosacea combined with hypertension,” the researchers said. [Hypertens Res 2011;34:790-791; Arch Dermatol 2011;147:1258-1260; J Invest Dermatol 2013;133:2480-2483]

Dyslipidaemia, on the other hand, is a known predictor of cardiovascular disease. Excess cholesterol deposition leading to plaque formation could occur in the endothelial lining, which then results in atherosclerosis, according to the researchers. [Atherosclerosis 2009;203:604-609; Atherosclerosis 2014;235:463-469]

“[A]ctivation of nucleotide binding oligomerization domain–like receptor 3 may cause interleukin 1β liberation, inducing lipoprotein structural alterations (eg, LDL and HDL), impeding their abilities to break down and transport cholesterol,” they said. “Therefore, chronic inflammation in patients with rosacea could be one possible explanation for dyslipidaemia.” [J Eur Acad Dermatol Venereol 2014;28:1165-1169]

Some limitations have to be considered, including (1) the shortcomings of observational studies included in the meta-analysis, such as unmeasured confounders and heterogeneity between different studies, (2) the absence of clinical data, which prevented subgroup analyses based on subtypes and severity of rosacea, (3) and the lack of analysis of publication bias due to the small sample size.

“To provide more solid evidence, future studies exploring underlying mechanisms and interactions are necessary,” the researchers noted.