Systemic Sclerosis Increases Heart Attack Risk

Alice Goodman

October 30, 2013

SAN DIEGO — The risk for myocardial infarction (MI) is almost 4 times higher in patients with systemic sclerosis than in control subjects, according to a large population-based study. In the first year after diagnosis, the risk is 8 times higher.

"It is becoming clear that systemic sclerosis has a strong macrovascular component, and cardiovascular disease is the leading cause of nonsystemic sclerosis-related death," said Antonio Avina-Zubieta, MD, from the Arthritis Research Centre of Canada in Richmond and the University of British Columbia in Vancouver.

"This study supports increased surveillance, prevention efforts, and modification of cardiovascular risk factors for patients with systemic sclerosis," he noted.

Dr. Avina-Zubieta presented the study findings during a plenary session here at the American College of Rheumatology (ACR) 2013 Annual Meeting.

"We suspected that a condition like systemic sclerosis marked by systemic inflammation would increase cardiovascular risk, but we needed to study it," said ACR president Audrey Uknis, MD, from Temple University School of Medicine in Philadelphia.

This is the first truly population-based study that has been done on the risk for MI in systemic sclerosis.

"This is the first truly population-based study that has been done on the risk for MI in systemic sclerosis. We see that the risk is much higher than it is in patients with rheumatoid arthritis, and as high as it is in those with lupus. The study suggests that rheumatologists need to be vigilant in following these patients," Dr. Avina-Zubieta emphasized.

It is well known that premature atherosclerosis occurs in patients with rheumatoid arthritis and systemic lupus erythematosus. Emerging evidence suggests that this also occurs in patients with systemic sclerosis. However, before this study, no research had been done on the risk for MI in patients with systemic sclerosis, Dr. Uknis explained.

His team used 4 large databases totaling about 5 million people. These databases included all outpatient visits, all hospital admissions, the drugs prescribed, and deaths.

Each of the 1245 incident cases of systemic sclerosis was paired with 10 age- and sex-matched healthy control subjects (n = 12,678).

Median age was about 53 years, and roughly 83% of the cohort was female. At baseline, Charlson comorbidity score was significantly higher in the sclerosis group than in the control group, as were the number of hospitalizations and the number of risk factors for MI.

At a median follow-up of 3.5 years, the rate of MI per 1000 person-years was higher in the sclerosis group than in the control group (20.2 vs 5.3).

Although the risk for MI was 8 times higher in the sclerosis group than in the control group in the first year after diagnosis, this decreased over time.

In general, risk increased with age. The risk for MI was about 7 times higher in sclerosis patients 45 to 59 years of age than in those younger than 45 years, who had no increased risk.

Among the strengths of this study are the large sample size and the fact that adjustments were made for precomorbidity and medications. Limitations include the way cases of systemic sclerosis and potential confounders were identified. However, a sensitivity analysis adjusted for potential confounders found similar results.

Dr. Avina-Zubieta has disclosed no relevant financial relationships. Dr. Uknis reports receiving research grants and consulting fees from ABIM, Biogen-Idec, and Roche.

ACR 2013 Annual Meeting: Abstract 763. Presented October 27, 2013.


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