Increased risk of ischemic stroke in systemic sclerosis: A national cohort study of US veterans

David Ying, Milena A. Gianfrancesco, Laura Trupin, Jinoos Yazdany, Eric L. Greidinger, Gabriela Schmajuk

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective. 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. Methods.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. Results. 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. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)82-88
Number of pages7
JournalJournal of Rheumatology
Issue number1
StatePublished - 2020


  • Matched-pair analysis
  • Proportional hazards models
  • Stroke
  • Systemic sclerosis
  • Veterans health

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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