Atopic Dermatitis and Markers of Early Cardiovascular Risk in Children and Adolescents.

Importance: Early identification of individuals at elevated risk of cardiovascular disease and preventive treatment during childhood may reduce cardiovascular disease in adults with chronic inflammatory diseases. Children with atopic dermatitis (AD) may have elevated cardiovascular risk, but studies to date have not accounted for heterogeneity in disease activity and severity across childhood. Objectives: To evaluate whether active and more severe AD across childhood and adolescence are associated with cardiovascular risk. Design, Setting, and Participants: This longitudinal cohort study used data collected from 1991 to 2017 for the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in the United Kingdom. Participants included children alive at 1 year with assessment of AD and at least 1 cardiovascular disease risk factor at a minimum of 1 time point. Data were analyzed November 30, 2022, to February 20, 2025. Exposures: Repeated assessments of AD activity and severity across childhood and adolescence. Main Outcomes and Measures: The primary outcome was cardiometabolic risk scores calculated at ages 15, 17, and 24 years. Secondary outcomes included body mass index, blood pressure, and lipid profiles measured up to 12 times between ages 3 and 24 years and ultrasonography measures of subclinical atherosclerosis at ages 17 and 24 years. Results: The subcohort included 9281 children, of whom 4669 (50.31%) were male. The analysis included 1001 participants (10.79%) 3 years of age, 908 (9.78%) 4 years, 838 (9.03%) 5 years, 6352 (68.44%) 7 years, 6205 (66.86%) 10 years, 5629 (60.65%) 11 years, 4968 (53.53%) 13 years, 3502 (37.73%) 15 years, 4738 (51.05%) 17 years, and 3626 (39.07%) 24 years of age. The prevalence of active AD varied by age and ranged from 13.10% to 21.58% at ages 3 through 18 years. Among participants with AD, 3.52% to 6.85% reported moderate or severe disease at each age. Multivariable linear regression models did not reveal associations between active AD and most cardiovascular risk factors; only 2 associations between AD and low-density lipoprotein cholesterol levels were found with P < .05, but they differed in the directionality of association at ages 3 and 10 years (mean difference, -0.33 [95% CI, -0.58 to -0.07] SDs for 3 years vs 0.14 [95% CI, 0.03-0.24] SDs at 10 years). There was no consistent evidence for dose-response effects by AD severity. There were also no associations between patterns of more active and severe AD across childhood with subclinical atherosclerosis. Conclusions and Relevance: In a population-based UK cohort of children and adolescents followed up into early adulthood, AD, including more active and severe disease over time, was not associated with increases in markers of cardiovascular risk. This finding suggests that systematic screening of all children with AD is unlikely to improve identification of early cardiovascular risk.