Cardiovascular Comorbidities and Risk in Hidradenitis Suppurativa: A Systematic Review and Meta-analysis

Abstract Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with cardiometabolic morbidity, yet published estimates of cardiovascular comorbidities and cardiovascular risk in HS vary widely. Objectives To quantify the prevalence of cardiovascular comorbidities among individuals with HS and to evaluate associations between HS and cardiovascular outcomes compared with individuals without HS. Methods This systematic review and meta-analysis is reported in accordance with PRISMA 2020. CINAHL, Cochrane, Embase, PubMed and Scopus were searched from inception through 16 June 2025. Eligible studies included individuals with clinician-diagnosed HS, ascertained by medical records, diagnostic codes, or physician assessment, that reported cardiovascular comorbidity prevalence or association estimates. For prevalence analyses, studies reported cardiovascular comorbidity prevalence within HS cohorts; for association analyses, studies included both participants with HS and a comparison group without HS. The most adjusted estimate available was preferentially selected for each study-outcome pair; when adjusted estimates were unavailable, the only reported estimate was retained. Risk of bias was assessed using Joanna Briggs Institute checklists, and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses were used for pooled estimates. Results Twenty-five studies met inclusion criteria, comprising 373,689 individuals with HS; 24 contributed prevalence data and 17 contributed association estimates. Hypertension was the most frequently reported cardiovascular comorbidity, affecting approximately one-quarter of patients, followed by coronary artery disease, cerebrovascular disease, congestive heart failure and myocardial infarction. Meta-analyses demonstrated that HS was associated with increased risk of multiple cardiovascular outcomes compared with individuals without HS, with relative risks generally ranging from 1.3- to 1.8-fold for ischemic or coronary heart disease, composite cardiovascular disease, myocardial infarction, heart failure, venous thromboembolism and all-cause mortality. Associations remained directionally consistent in sensitivity analyses, although substantial heterogeneity was present across most analyses. Certainty of evidence was low, reflecting the observational design of included studies and variability in confounder adjustment. Conclusions HS is associated with a substantial burden of cardiovascular comorbidities and increased risk of several major cardiovascular outcomes. These findings support consideration of cardiovascular risk assessment in the clinical management of HS while highlighting the need for prospective studies with standardized cardiovascular outcome definitions and more consistent adjustment for key confounders.