TY - JOUR
T1 - Systemic sclerosis is an independent risk factor for ischemic heart disease, especially in patients carrying certain antiphospholipid antibodies
T2 - A large cross-sectional study
AU - Watad, Abdulla
AU - McGonagle, Dennis
AU - Bragazzi, Nicola L.
AU - Damiani, Giovanni
AU - Comaneshter, Doron
AU - Lidar, Merav
AU - Cohen, Arnon D.
AU - Amital, Howard
N1 - Publisher Copyright:
© 2020
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background: A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis (SSc) was reported. However, contrasting findings were published concerning the role of SSc-related autoantibodies in IHD risk which remains controversial. The current study explored the link between SSc and IHD, impact of putative links on SSc mortality and the role of SSc-related and antiphospholipid autoantibodies in disease associated IHD. Methods: A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted on 2431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD was compared between patients diagnosed with SSc and age- and gender-matched controls. The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD was assessed. Results: The prevalence rate of IHD was significantly higher in SSc than controls (20.4% vs 15.0%, p <0.001). At the multivariate analysis, SSc was an independent predictor of IHD with an OR of 1.91 (95%CI 1.57–2.31, p < 0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI 2.03–3.53, p < 0.0001) than those without IHD. In SSc patients positivity for anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) represented a risk factor for IHD with an OR 1.89 (95% 1.04–3.45, p = 0.0369) and OR of 3.72 (95% 1.25–11.11, p = 0.0184), respectively. Conclusions: Patients with SSc are at higher risk for developing IHD with an additional risk for the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion is needed during routine patient follow-up and pre-emptive screening should be considered.
AB - Background: A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis (SSc) was reported. However, contrasting findings were published concerning the role of SSc-related autoantibodies in IHD risk which remains controversial. The current study explored the link between SSc and IHD, impact of putative links on SSc mortality and the role of SSc-related and antiphospholipid autoantibodies in disease associated IHD. Methods: A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted on 2431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD was compared between patients diagnosed with SSc and age- and gender-matched controls. The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD was assessed. Results: The prevalence rate of IHD was significantly higher in SSc than controls (20.4% vs 15.0%, p <0.001). At the multivariate analysis, SSc was an independent predictor of IHD with an OR of 1.91 (95%CI 1.57–2.31, p < 0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI 2.03–3.53, p < 0.0001) than those without IHD. In SSc patients positivity for anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) represented a risk factor for IHD with an OR 1.89 (95% 1.04–3.45, p = 0.0369) and OR of 3.72 (95% 1.25–11.11, p = 0.0184), respectively. Conclusions: Patients with SSc are at higher risk for developing IHD with an additional risk for the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion is needed during routine patient follow-up and pre-emptive screening should be considered.
KW - Antiphospholipids antibodies
KW - Autoimmune diseases
KW - Ischemic heart disease
KW - Scleroderma
KW - Systemic sclerosis
UR - http://www.scopus.com/inward/record.url?scp=85087214529&partnerID=8YFLogxK
U2 - 10.1016/j.ejim.2020.06.022
DO - 10.1016/j.ejim.2020.06.022
M3 - Article
C2 - 32620499
AN - SCOPUS:85087214529
SN - 0953-6205
VL - 81
SP - 44
EP - 49
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
ER -