The team followed patients until the development of ischemic stroke, death or their last encounter. They used a Cox proportional regression model to estimate risk of ischemic stroke. Next, they calculated an adjusted risk by adjusting for cardiovascular comorbidities of hypertension, diabetes, atrial fibrillation, non-cerebrovascular atherosclerotic disease and hyperlipidemia, as well as the baseline use of aspirin, non-steroidal anti-inflammatory drugs and Medicare enrollment.
Higher Risk in SSc Patients
The researchers documented an incidence rate of ischemic stroke of 15.3 per 1,000 person-years in SSc patients with 12.2 per 1,000 person-years in the control cohort. The incidence of ischemic stroke between the two groups diverged early in the follow-up period. The divergence translated into an unadjusted hazard ratio of 1.28 and an adjusted hazard ratio of 1.21. The hazard ratio remained consistent for all sensitivity analyses.
Investigators conclude the risk of incident stroke or transient ischemic attack was 20–30% higher in individuals with SSc than in matched controls. Additionally, although cases had a significantly higher prevalence of traditional cardiovascular risk factors than controls, researchers note the increased risk of cerebrovascular disease in SSc patients was independent of these traditional cardiovascular risk factors.
“In this study, we found scleroderma is associated with ischemic stroke,” says Gabriela Schmajuk, MD, a rheumatologist at UCSF and co-author of the paper. “This [finding] is important because we don’t traditionally think about large vessel disease, such as stroke and heart attack, in these patients. We were surprised by the number of patients in the VA system who we found with this diagnosis. We were able to put together the largest cohort of patients with scleroderma to date.”
Dr. Schamjuk also emphasized that, although previous studies have found similar results in women, their study is much larger than any previously published research. This suggests rheumatologists should worry about ischemic stroke in women, as well as men.
Lara C. Pullen, PhD, is a medical writer based in the Chicago area.
References
- Ying D, Gianfrancesco MA, Trupin L, et al. Increased risk of ischemic stroke in systemic sclerosis: A national cohort study of U.S. veterans. J Rheumatol. 2020 Jan;47(1):82–88.
