Section of Rheumatology, Boston University School of Medicine, Boston, MA 02118, USA.
Ann Rheum Dis. 2013 Jul;72(7):1188-93. doi: 10.1136/annrheumdis-2012-202007. Epub 2012 Aug 17.
To evaluate the risk of incident myocardial infarction (MI), stroke and peripheral vascular disease (PVD) in individuals with systemic sclerosis (SSc) in a general population context.
We conducted a cohort study using a UK primary care database containing records from 1986 to 2011. SSc diagnoses, outcomes and cardiovascular risk factors were identified from electronic medical records. We conducted two cohort analyses: (1) MI and stroke, and (2) PVD, excluding individuals with prevalent disease at baseline for each analysis. We estimated HRs comparing SSc with age-, sex- and entry time-matched comparison cohorts, adjusting for potential cardiovascular risk factors.
Among 865 individuals with SSc (85.8% women, mean age 58.7 years), the incidence rates (IRs) of MI and stroke were 4.4 and 4.8 per 1000 person-years (PY), versus 2.5 and 2.5 per 1000 PY in the comparison cohort. The corresponding adjusted HRs were 1.80 (95% CI 1.07 to 3.05) for MI and 2.61 (95% CI 1.54 to 4.44) for stroke. Among 858 individuals with SSc (85.3% female, mean age 58.9 years), the IR of PVD was 7.6 per 1000 PY versus 1.9 per 1000 PY in the comparison cohort, with an adjusted HR of 4.35 (95% CI 2.74 to 6.93).
These findings provide the first general population-based evidence that SSc is associated with an increased risk of developing MI, stroke and PVD. Further insight into disease mechanisms, as well as how disease subtype, organ involvement and medication use may alter these increased risks, is needed.
在一般人群背景下，评估系统性硬化症（SSc）个体发生心肌梗死（MI）、中风和外周血管疾病（PVD）的风险。
我们进行了一项队列研究，使用包含 1986 年至 2011 年记录的英国初级保健数据库。从电子病历中确定 SSc 诊断、结局和心血管危险因素。我们进行了两项队列分析：（1）MI 和中风；（2）PVD，在每种分析中均排除基线时存在既往疾病的个体。我们比较了 SSc 与年龄、性别和进入时间匹配的比较队列，调整了潜在的心血管危险因素，估计了 HR。
在 865 名 SSc 患者（85.8%为女性，平均年龄 58.7 岁）中，MI 和中风的发生率（IRs）分别为每 1000 人年 4.4 和 4.8 例，而在比较队列中分别为每 1000 人年 2.5 和 2.5 例。相应的调整后 HR 分别为 MI 1.80（95%CI 1.07 至 3.05）和中风 2.61（95%CI 1.54 至 4.44）。在 858 名 SSc 患者（85.3%为女性，平均年龄 58.9 岁）中，PVD 的 IR 为每 1000 人年 7.6 例，而在比较队列中为每 1000 人年 1.9 例，调整后 HR 为 4.35（95%CI 2.74 至 6.93）。
这些发现提供了首个基于一般人群的证据，表明 SSc 与发生 MI、中风和 PVD 的风险增加有关。需要进一步深入了解疾病机制，以及疾病亚型、器官受累和药物使用如何改变这些增加的风险。
