Implementing the association between rosacea, hypertension, and dyslipidemia in clinical practice

To the Editor: We read with great interest Chen et al's1Chen Q. Shi X. Tang Y. et al.Association between rosacea and cardiometabolic disease: a systematic review and meta-analysis.J Am Acad Dermatol. 2020; 83: 1331-1340Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar article titled “Association between rosacea and cardiometabolic disease: A systematic review and meta-analysis.” Chen et al1Chen Q. Shi X. Tang Y. et al.Association between rosacea and cardiometabolic disease: a systematic review and meta-analysis.J Am Acad Dermatol. 2020; 83: 1331-1340Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar report that rosacea is associated with hypertension and dyslipidemia and suggest that health care providers could screen patients with rosacea for cardiometabolic indicators. However, it is unclear if such associations may translate to clinical practice. Patients who are living with undiagnosed hypertension may develop detrimental effects to their health, including heart failure, kidney disease, and coronary artery disease.2Buhnerkempe M.G. Prakash V. Botchway A. et al.Adverse health outcomes associated with refractory and treatment-resistant hypertension in the chronic renal insufficiency cohort.Hypertension. 2021; 77: 72-81Crossref PubMed Scopus (2) Google Scholar Preventing such complications may be achieved with early screening. Therefore, the United States Preventative Services Task Force (USPSTF) recommends annually screening for hypertension in all patients ≥18 years of age. Although patients with rosacea are more likely to present with concomitant hypertension, such patients are already annually screened by their primary care provider for hypertension according to the USPSTF guidelines. In addition, because rosacea affects individuals 20 to 50 years of age, the USPSTF guidelines already recommend screening for hypertension well before a patient may develop rosacea.3Siu A.L. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2015; 163: 778-786Crossref PubMed Scopus (300) Google Scholar Dermatologists may not need to screen their patients with rosacea for hypertension, as such patients already receive earlier annual screening by their primary care provider according to the recommended guidelines. However, dermatologists can ensure that their patients are being regularly screened for hypertension by their primary care provider. Chen et al1Chen Q. Shi X. Tang Y. et al.Association between rosacea and cardiometabolic disease: a systematic review and meta-analysis.J Am Acad Dermatol. 2020; 83: 1331-1340Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar reported an association between rosacea and dyslipidemia. The USPSTF guidelines recommend screening all males ≥35 years of age and women ≥45 years of age for dyslipidemia. The guidelines further recommend screening earlier, at 20 years of age, when patients are at risk of coronary heart disease because of having such risk factors as diabetes mellitus, hypertension, tobacco use, cardiovascular disease, or obesity.4Schonmann Y. Bleich O. Matalon A. Yeshua H. Validation of the 2016 USPSTF recommendations for primary cardiovascular prevention in a large contemporary cohort.Eur J Prev Cardiol. 2018; 25: 870-880Crossref PubMed Scopus (5) Google Scholar Compared with the aforementioned risks of coronary heart disease, there is insufficient evidence to suggest screening for dyslipidemia in patients with rosacea who are ≥20 years of age because we do not know if implementing such screening tests are cost effective or if they improve cardiovascular morbidity and mortality among patients with rosacea. As we continue to learn more about the cardiometabolic associations with dermatologic conditions, larger studies assessing the cost effectiveness and the morbidity and mortality benefits of controlling these cardiometabolic conditions associated with such dermatologic conditions could influence future guidelines in screening for hypertension, diabetes, heart disease, and lipid derangements among dermatologic patients. It is reasonable for dermatologists to be aware of the association among rosacea, hypertension, and dyslipidemia and to ensure that their patients are being followed by their primary care provider for routine screening of hypertension and dyslipidemia. None disclosed. Association between rosacea and cardiometabolic disease: A systematic review and meta-analysisJournal of the American Academy of DermatologyVol. 83Issue 5PreviewRosacea is recognized as a chronic inflammatory cutaneous disorder associated with multiple systemic illnesses. However, the association between rosacea and cardiometabolic disease (CMD) remains controversial. Full-Text PDF Open AccessReplyJournal of the American Academy of DermatologyVol. 85Issue 3PreviewTo the Editor: It is a great pleasure to clarify questions about whether the association between rosacea, hypertension, and dyslipidemia may translate to clinical practice. We appreciate the thoughtful comments by Drs Pona, Labbe, Afriyie, Jiwani, and Powell to our article and thank them for their contributions surrounding the hypertension and dyslipidemia screening guidelines. Full-Text PDF