PT  - JOURNAL ARTICLE
AU  - David Ying
AU  - Milena A. Gianfrancesco
AU  - Laura Trupin
AU  - Jinoos Yazdany
AU  - Eric L. 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  - 2020 Jan 01
TA  - The Journal of Rheumatology
PG  - 82--88
VI  - 47
IP  - 1
4099  - http://www.jrheum.org/content/47/1/82.short
4100  - http://www.jrheum.org/content/47/1/82.full
SO  - J Rheumatol2020 Jan 01; 47
AB  - 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.