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J Rheumatol. 2019 Mar 15. pii: jrheum.181311. doi: 10.3899/jrheum.181311. [Epub ahead of print]

Increased Risk of Ischemic Stroke in Systemic Sclerosis: A National Cohort Study of US Veterans.

Author information

1
From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA. This study was funded by the US Department of Veterans Affairs Merit Review grant (EG), the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH/NIAMS) K23 AR063770 (GS), and NIH/NIAMS P30 AR070155 (JY). This project was also supported by the National Center for Advancing Translational Sciences, NIH, through the University of California, San Francisco Clinical and Translational Science Institute (UCSF-CTSI grant number UL1 TR001872), and the Rosalind Russell/Ephraim Engleman Rheumatology Research Center. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the NIH, the Department of Veterans Affairs, or the US government. D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work. Address correspondence to Dr. D. Ying, Division of Rheumatology, Department of Medicine, University of California, San Francisco, 4150 Clement St., 111R, San Francisco, California 94121, USA. E-mail: David.Ying@ucsf.edu. Accepted for publication February 27, 2019.

Abstract

OBJECTIVE:

Previously thought to involve primarily the microvasculature, systemic sclerosis (SSc) has been increasingly linked to macrovascular disease. Cardiovascular (CV) and cerebrovascular disease are responsible for 20-30% of mortality in SSc, but few studies have shown an independent association between SSc and stroke. We assessed whether SSc was an independent risk factor for ischemic stroke.

METHODS:

We conducted a retrospective cohort study using the national Veterans Affairs (VA) administrative database containing records from 1999 to 2014. We obtained data for all patients with a diagnosis of SSc as well as 2 controls per SSc patient matched on sex, race, smoking status, and VA site. All patients were followed until development of ischemic stroke, death, or last encounter. We used a Cox proportional hazard regression model to estimate risk of ischemic stroke, with adjustments for CV comorbidities (hypertension, diabetes, atrial fibrillation, non-cerebrovascular atherosclerotic disease, hyperlipidemia), baseline medication use (aspirin, nonsteroidal antiinflammatory drugs), and Medicare enrollment.

RESULTS:

Among 4545 individuals with SSc (83% male, mean age 60.9 yrs), the incidence rate of ischemic stroke was 15.3 per 1000 person-years (vs 12.2 in the control cohort), with an unadjusted HR 1.28 (95% CI 1.11-1.47). The adjusted HR was 1.21 (95% CI 1.05-1.40) after adjusting for baseline CV risk factors, medications, and Medicare enrollment.

CONCLUSION:

SSc is independently associated with a higher risk of ischemic stroke among US veterans. Patients with SSc represent a population likely to benefit from targeted stroke screening or prevention therapies.

PMID:
30877213
DOI:
10.3899/jrheum.181311

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