Hidradenitis Suppurativa and Atherosclerosis: Understanding the Cardiovascular Link
Hidradenitis Suppurativa (HS) is more than a skin condition - it is a systemic inflammatory disease that can impact various aspects of health, including cardiovascular well-being. This deep-dive explores the significant connection between HS and atherosclerosis, a condition characterized by plaque buildup in the arteries, and how understanding this link is crucial for comprehensive patient care.
2x
Higher risk of CAD in HS patients [1]
40%+
Adults 50-64 with subclinical atherosclerosis [6]
47.3%
Severe HS patients with obesity [3]
Independent
HS is an independent risk factor for subclinical atherosclerosis [4]
The Inflammatory Bridge: HS and Atherosclerosis
Both Hidradenitis Suppurativa and atherosclerosis are characterized by chronic inflammation. The persistent systemic inflammation inherent in HS contributes significantly to the initiation and progression of atherosclerosis, making it a critical comorbidity for HS patients. [1, 4, 5]
Unpacking the Connection: How HS Influences Atherosclerosis
1. Chronic Systemic Inflammation
HS is marked by persistent, widespread inflammation, leading to elevated levels of pro-inflammatory cytokines like TNF-alpha and IL-6. These powerful signaling molecules are not confined to the skin; they circulate throughout the body, playing a pivotal role in the development and progression of atherosclerotic plaques within arterial walls. [1, 4, 7, 8]
2. Endothelial Dysfunction
The systemic inflammatory state in HS can damage the endothelium - the inner lining of blood vessels. This damage, known as endothelial dysfunction, is an early and crucial step in atherosclerosis. It impairs the blood vessels' ability to relax and widen, and promotes the adhesion of inflammatory cells and lipids, setting the stage for plaque formation. [9]
3. Shared Risk Factors
Individuals with HS frequently present with a higher prevalence of traditional cardiovascular risk factors. These include conditions such as obesity, metabolic syndrome, hypertension, and diabetes. These comorbidities independently accelerate the atherosclerotic process, compounding the risk already posed by HS-related inflammation. [2, 3, 5]
4. Oxidative Stress
Chronic inflammation and dyslipidemia (abnormal lipid levels) commonly seen in HS patients can lead to increased oxidative stress. This imbalance damages vascular cells and promotes the oxidation of low-density lipoproteins (LDL), a key event in the development and progression of atherosclerotic plaques. This further contributes to arterial hardening and narrowing.
Shared Risk Factors: HS and Atherosclerosis
| Risk Factor | Prevalence in HS Patients | Impact on Atherosclerosis |
|---|---|---|
| Obesity | Up to 47.3% in severe HS [3] | Major independent risk factor; contributes to inflammation and metabolic dysfunction. |
| Hypertension | Up to 40.2% in severe HS [3] | Increases arterial wall stress and promotes endothelial damage. |
| Diabetes Mellitus | Elevated prevalence in severe HS [3] | Contributes to endothelial dysfunction, inflammation, and oxidative stress. |
| Metabolic Syndrome | Higher prevalence in HS patients [5] | Cluster of conditions (obesity, high blood pressure, high blood sugar, abnormal cholesterol) that significantly raise cardiovascular risk. |
| Smoking | Common trigger/aggravating factor for HS; higher prevalence in HS patients. | Directly damages endothelium, promotes inflammation, and increases LDL oxidation. |
Warning Signs and When to Seek Help
Recognizing Potential Cardiovascular Issues
- Chest pain or discomfort: Especially if it occurs with exertion or stress.
- Shortness of breath: Difficulty breathing, particularly during activity or when lying down.
- Palpitations: A feeling of a racing, pounding, or fluttering heart.
- Unexplained fatigue: Persistent tiredness that isn't relieved by rest.
- Swelling in legs or ankles: Can indicate fluid retention related to heart issues.
- Dizziness or lightheadedness: Especially when standing up quickly.
Care Coordination and Proactive Management
If you have Hidradenitis Suppurativa and experience any of the warning signs listed above, it is crucial to seek medical attention promptly. Do not dismiss these symptoms, as early detection and management of cardiovascular issues can significantly improve outcomes.
Regular cardiovascular risk assessments and screenings are highly recommended for all HS patients, particularly those with moderate to severe disease or additional risk factors like obesity, hypertension, or diabetes. Work closely with your dermatologist and primary care physician, and consider a referral to a cardiologist for comprehensive care. A coordinated approach ensures that both your HS and cardiovascular health are optimally managed.
Frequently Asked Questions
Explore Other HS Comorbidities
HS and Metabolic Syndrome
Understand the strong link between HS and metabolic syndrome, a cluster of conditions that increase your risk of heart disease, stroke, and type 2 diabetes.
HS and Obesity
Delve into how obesity impacts HS severity and progression, and the importance of weight management in HS care.
HS and Hypertension
Learn about the increased prevalence of high blood pressure in HS patients and its implications for overall cardiovascular health.
References
- Worapongsatitaya, P. (2023). Hidradenitis Suppurativa and Risk of Coronary Artery Disease. PMC, 10564198.
- ACC. (2025, March 21). When Lesions Go Deep: Hidradenitis Suppurativa and Cardiovascular Risk. American College of Cardiology.
- Dermatology Advisor. (2025, October 28). Severe Hidradenitis Suppurativa Linked to Higher Cardiometabolic and ASCVD Risk. Dermatology Advisor.
- Oba, M. C. (2023). Subclinical atherosclerosis in patients with hidradenitis suppurativa. PMC, 10155849.
- González-López, M. A. (2016). Increased prevalence of subclinical atherosclerosis in patients with hidradenitis suppurativa. ScienceDirect, S0190962216300081.
- American Heart Association. (2021, September 20). More than 40% of adults with no known heart disease had fatty deposits in heart arteries. AHA Newsroom.
- Libby, P. (2002). Inflammation and Atherosclerosis. Circulation, 10.1161/hc0902.104353.
- Ajoolabady, A. (2024). Inflammation in atherosclerosis: pathophysiology and therapeutic implications. Nature, s41419-024-07166-8.
- González-López, M. A. (2022). Biomarkers of endothelial dysfunction and atherosclerosis in hidradenitis suppurativa. The Journal of Dermatology, 1346-8138.16484.
Content reviewed for medical accuracy. Always consult a qualified healthcare provider.
Medical Disclaimer
The information provided on this page is for educational and informational purposes only, and is not intended as medical advice, diagnosis, or treatment. Hidradenitis Suppurativa is a complex medical condition requiring professional evaluation and care.
Always seek the guidance of a qualified physician or other healthcare professional for any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the War Against HS website.
The authors and publishers of this website are not responsible for any actions taken based on the information presented herein.