Abstract
Aim: The aim of this study is to describe the clinical characteristics of patients with a diagnosis of systemic sclerosis who later suffer a stroke and to identify associations for this relationship. Background: Prior studies have showed an increased risk of cardiovascular disease among patients with chronic inflammatory disorders, with chronic inflammation leading to atherosclerosis believed to be the culprit. Systemic sclerosis (SSc) is a chronic inflammatory disease characterized by diffuse fibrosis of the skin and internal organs. Previous studies have suggested a possible link between systemic sclerosis and macrovascular complications such as stroke. Methods: This is a retrospective chart review of patients treated within the University of Pennsylvania Health System from October 2015 to April 2019 with a diagnosis of SSc. Using ICD10 codes, we identified a cohort of SSc patients who suffered a stroke. Information regarding demographics and stroke risk factors were gathered from the charts of patients with a diagnosis of both SSc plus stroke and compared to a control group of randomly selected patients with SSc who never suffered a stroke. Continuous variables were conveyed using a mean plus a standard deviation. A two-sample t-test was used to compare the two groups of patients. Qualitative variables were compared using a two-tailed Fisher’s exact test. Results: Based on a large cohort of SSc patients (n = 2080) followed between October 2015 and April 2019, we identified 36 SSc patients who developed a subsequent stroke (1.7% of cohort). When looking at risk factors for stroke in SSc patients, we identified hypertension and atrial fibrillation to be associated with the diagnosis of stroke in such patients. Specifically, 28 of the 36 patients with both SSc and stroke also had a diagnosis of hypertension while in the control group, only 17 of 36 patients had hypertension. Atrial fibrillation was seen in 9 of 36 patients with both SSc and CVA while it was seen in only 2 of 36 patients in the control group. Conclusions: This case control study demonstrated that the presence of hypertension and atrial fibrillation had a statistically significant association with the diagnosis of CVA in patients with SSc.
Highlights
Systemic sclerosis (SSc) is a chronic autoimmune rheumatic disorder characterized by both cellular and humoral immune dysregulation, excessive extracellular matrix and collagen deposition in the skin and internal organs, and microvasculature dysregulation
When looking at risk factors for stroke in SSc patients, we identified hypertension and atrial fibrillation to be associated with the diagnosis of stroke in such patients
From 2080 SSc patients actively followed within the University of Pennsylvania Health System from October 2015 to April 2019, 36 (1.7% of the actively followed SSc population) patients were diagnosed with a Cerebrovascular accidents (CVA) following their diagnosis of SSc
Summary
Systemic sclerosis (SSc) is a chronic autoimmune rheumatic disorder characterized by both cellular and humoral immune dysregulation, excessive extracellular matrix and collagen deposition in the skin and internal organs, and microvasculature dysregulation. It has been shown that there is an increased risk for cardiovascular disease among patients with other chronic autoimmune rheumatic disorders, with chronic inflammation leading to atherosclerosis believed to be the culprit [1]. Inflammation incites the development of atherosclerotic plaques and contributes to the degradation of their overlying fibrous caps, contributing to plaque rupture and subsequent coronary artery infarction [4]. Proinflammatory cytokines may influence the release of matrix metalloproteinases, disrupting the balance of elastin and collagen while increasing plaque vulnerability through plaque remodeling and degradation of the fibrous cap [5]
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