Clustering analysis of circulating plasma-biomarkers in atopic dermatitis reveals a distinct-inflammatory cardiac risk profile in African American patients.

Atopic dermatitis (AD) is a heterogeneous inflammatory skin disease associated with increased cardiovascular risk, disproportionately affecting African Americans (AA). However, AA patients' cardiac risk profile in AD remains unclear. Plasma from 42 moderate-to-severe AD patients (worst itch numeric rating scale [WI-NRS] ≥ 7, investigator global assessment scale [IGA] ≥ 3) and 37 matched healthy controls (HC) were assayed for 9 cardiovascular disease proteins. A multi-center analysis was performed to compare cardiovascular comorbidities and inflammatory biomarkers racially. African American AD patients had higher C-reactive protein (CRP) (30.9 mg/L AA vs. 23.8 HC), positively correlating with WI-NRS (r = 0.34). Hierarchical clustering identified two clusters: Cluster 2 (80% AA, n = 4) showing elevated CRP (160 mg/mL vs. 10), haptoglobin (532.2 mg/dL vs. 55.8), α1-acid glycoprotein (0.11 g/dL vs. 0.08), and serum amyloid P (0.48 mg/dL vs. 0.32) compared to Cluster 1 (59% AA, n = 22). Multi-center data revealed AA AD patients had increased risk of ischemic heart disease, hypertension, and atherosclerosis than Caucasian Americans (CA) AD patients, along with elevated pro-inflammatory markers (CRP, ferritin, ESR, and eosinophils). The study's cross-sectional retrospective design prevents establishing causality. Our results highlight an increased cardiac risk and systemic inflammatory profile in AA patients with AD.