# Increased risk of cardiac arrhythmia in Hailey-Hailey disease patients

## TL;DR

People with Hailey-Hailey disease have a higher risk of heart arrhythmia, suggesting the condition may affect more than just the skin.

## Contribution

This is the first study to show an extracutaneous comorbidity in Hailey-Hailey disease, linking it to cardiac arrhythmia.

## Key findings

- HHD patients had a 40% higher risk of arrhythmia compared to those without HHD.
- No increased risk of myocardial infarction or heart failure was observed in HHD patients.
- ECG parameters, electrolytes, and cardiovascular biomarkers were similar between HHD patients and controls.

## Abstract

Hailey-Hailey disease (HHD) is a rare autosomal dominant skin disease caused by mutations in the ATP2C1 gene, which encodes the secretory Ca2+/Mn2+-ATPase (SPCA1) pump in the Golgi apparatus. Although ATP2C1 is ubiquitously expressed in the body, possible extracutaneous manifestations of HHD are unknown. However, dysfunction of the Golgi apparatus not specifically coupled to ATP2C1 has been associated with heart disease.

To investigate the association between HHD and common heart disease in a Swedish, population-based cohort.

We conducted a population-based cohort study based on a linkage of Swedish nationwide registers to investigate the relationship between HHD and heart disease. We have been granted ethical approval from the Swedish Ethical Review Authority to conduct this study. The patients in this manuscript have given written informed consent to the publication of their case details. A total of 342 individuals with an ICD-10 diagnosis of HHD (Q82.8E) were identified and matched with randomly selected comparison individuals without HHD on a 1:100 ratio. Furthermore, in a separate clinical cohort we matched 23 HHD patients for age, sex, and BMI with control subjects to examine electrocardiogram parameters, electrolytes, and cardiovascular biomarkers.

Compared with individuals without HHD, individuals with HHD had an excess risk of arrhythmia (RR 1.4, CI 1.0–2.0), whereas no increased risks of myocardial infarction (RR 1.1, CI 0.6–1.7) or heart failure (RR 1.0, CI 0.6–1.6; Table 1) were found. We found no difference in ECG parameters, cardiovascular biomarkers, and electrolytes in the clinical subset.

This study reveals that HHD is associated with an increased risk of arrhythmia and represents the first data of any extracutaneous comorbidity in HHD. Thus, HHD may be a systemic disease. Our findings also shed light on the importance of the Golgi apparatus’ Ca2+/Mn2+ homeostasis in common heart disease.