Ying David, Gianfrancesco Milena A, Trupin Laura, Yazdany Jinoos, Greidinger Eric L, Schmajuk Gabriela
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.
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.
J Rheumatol. 2020 Jan;47(1):82-88. doi: 10.3899/jrheum.181311. Epub 2019 Mar 15.
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.
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.
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.
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.
系统性硬化症（SSc）以前被认为主要累及微血管系统，现在越来越多地与大血管疾病相关联。心血管（CV）疾病和脑血管疾病导致SSc患者20%-30%的死亡，但很少有研究表明SSc与中风之间存在独立关联。我们评估了SSc是否为缺血性中风的独立危险因素。
我们使用国家退伍军人事务部（VA）的行政数据库进行了一项回顾性队列研究，该数据库包含1999年至2014年的记录。我们获取了所有诊断为SSc的患者以及每名SSc患者按性别、种族、吸烟状况和VA站点匹配的2名对照的数据。所有患者均随访至发生缺血性中风、死亡或最后一次就诊。我们使用Cox比例风险回归模型估计缺血性中风的风险，并对CV合并症（高血压、糖尿病、心房颤动、非脑血管动脉粥样硬化疾病、高脂血症）、基线用药情况（阿司匹林、非甾体抗炎药）和医疗保险参保情况进行了调整。
在4545例SSc患者中（83%为男性，平均年龄60.9岁），缺血性中风的发病率为每1000人年15.3例（对照组为12.2例），未调整的风险比（HR）为1.28（95%置信区间[CI]为1.11-1.47）。在对基线CV危险因素、用药情况和医疗保险参保情况进行调整后，调整后的HR为1.21（95%CI为1.05-1.40）。
在美国退伍军人中，SSc与缺血性中风风险较高独立相关。SSc患者是可能从针对性的中风筛查或预防治疗中获益的人群。
