Risk of ischaemic stroke up in individuals with systemic sclerosis

Systemic sclerosis (SSc) appears to increase the risk of ischaemic stroke, according to a study involving US veterans.

A total of 4,545 individuals (mean age, 60.9 years; 83 percent male) were included in the study. The incidence rate of ischaemic stroke in this population was 15.3 per 1,000 person-years compared with 12.2 in the control cohort (unadjusted hazard ratio [HR], 1.28, 95 percent confidence interval [CI], 1.11–1.47). The incidence rate remained consistent after adjusting for baseline cardiovascular (CV) risk factors, medications and Medicare enrolment (unadjusted HR, 1.21, 95 percent CI, 1.05–1.40).

SSc patients may benefit from targeted stroke screening or prevention therapies, the authors said.

This retrospective cohort study was conducted using the national Veterans Affairs (VA) administrative database, which contained records from 1999 to 2014. Data for all patients with SSc was obtained, including two controls per SSc patient matched on sex, race, smoking status and VA site. All patients were followed until development of ischaemic stroke, death or last encounter.

Cox proportional hazard regression model was used to estimate the risk of ischaemic stroke, adjusting for CV comorbidities (eg, hypertension, diabetes, atrial fibrillation, noncerebrovascular atherosclerotic disease, hyperlipidaemia), baseline medication use (eg, aspirin, nonsteroidal anti-inflammatory drugs) and Medicare enrolment.

“Previously thought to involve primarily the microvasculature, SSc has been increasingly linked to macrovascular disease,” according to the authors. “CV and cerebrovascular disease are responsible for 20–30 percent of mortality in SSc, but few studies have shown an independent association between SSc and stroke.”