PT - JOURNAL ARTICLE AU - David Ying AU - Milena A. Gianfrancesco AU - Laura Trupin AU - Jinoos Yazdany AU - Eric Greidinger AU - Gabriela Schmajuk TI - Increased risk of ischemic stroke in systemic sclerosis: a national cohort study of US veterans AID - 10.3899/jrheum.181311 DP - 2019 Mar 15 TA - The Journal of Rheumatology PG - jrheum.181311 4099 - http://www.jrheum.org/content/early/2019/03/11/jrheum.181311.short 4100 - http://www.jrheum.org/content/early/2019/03/11/jrheum.181311.full AB - Objective Previously thought to involve primarily the microvasculature, systemic sclerosis (SSc) has been increasingly linked to macrovascular disease. Cardiovascular and cerebrovascular disease are responsible for 20-30% of mortality in SSc, but few studies have shown an independent association between SSc and stroke. In this study, we assessed whether SSc was an independent risk factor for ischemic stroke. Methods We conducted a retrospective cohort study using the national Veterans Affairs administrative database containing records from 1999 to 2014. We obtained data for all patients with a diagnosis of SSc as well as two 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 with adjustments for cardiovascular comorbidities (hypertension, diabetes, atrial fibrillation, non-cerebrovascular atherosclerotic disease, hyperlipidemia), baseline medication use (aspirin, NSAIDs) and Medicare enrollment to estimate risk of ischemic stroke. Results Among 4,545 individuals with SSc (83% male, mean age 60.9 years), the incidence rate of ischemic stroke was 15.3 per 1000 person-years (versus 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 cardiovascular risk factors, medications and Medicare enrollment. Conclusion SSc is independently associated with a higher risk of ischemic stroke among U.S. veterans. Patients with SSc represent a population likely to benefit from targeted stroke screening or prevention therapies.