Atherosclerotic Cardiovascular Disease in Hospitalized Patients With Systemic Sclerosis: Higher Mortality Than Patients With Lupus and Rheumatoid Arthritis

Abstract

Objective. Systemic sclerosis (SSc; scleroderma) patients have an increased risk for atherosclerotic cardiovascular disease (ASCVD), possibly mediated through inflammatory and fibrotic mechanisms affecting the macrovasculature and microvasculature. We utilized the US Nationwide Inpatient Sample to assess the frequency of and mortality risk associated with ASCVD among hospitalized SSc patients. Methods. We examined the frequency and mortality associated with primary diagnoses and procedures related to ASCVD among adult SSc patients using data from 1993 to 2007. Using multivariate logistic regression (controlling for age, sex, nonelective admission, and modified Charlson Comorbidity Index), we compared the odds of death among hospitalized SSc patients with ASCVD to those with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), as well as to a control group that excluded patients with connective tissue diseases.

Central Hemodynamics and Arterial Stiffness in Systemic Sclerosis

“…37 El riesgo de muerte durante la hospitalización es más alto en los pacientes con ES y enfermedad cardiovascular aterosclerótica que en los pacientes con esclerodermia sin evidencia de enfermedad cardiovascular y que los pacientes con otras enfermedades inflamatorias sistémicas. 38 El papel del compromiso microvascular y macrovascular en la patogenia de la enfermedad cardiovascular en la ES aún sigue representando un desafío. 39 La compleja interacción entre daño vascular, fibrosis y autoinmunidad convierte a la ES en un modelo interesante para investigar la fisiopatología del daño aterosclerótico en las enfermedades sistémicas autoinmunitarias.…”

“…37 Patients with SSc with atherosclerotic cardiovascular disease have a higher risk of death during hospitalization in comparison to scleroderma patients without evidence of cardiovascular disease and to patients with other systemic inflammatory diseases. 38 The role of microvascular and macrovascular involvement in the pathogenesis of cardiovascular disease in SSc still remains a challenge. 39 The complex interplay of vascular 40 The investigation of surrogate measures of vascular disease and early vascular aging may help to understand the factors underlying the increased rate of cardiovascular events reported in SSc.…”

Subclinical Atherosclerosis in Systemic Sclerosis: Not Less Frequent Than Rheumatoid Arthritis and Not Detected With Cardiovascular Risk Indices

“…Recently, analysis of a large hospitalization database revealed that 5.4% of 308,452 SSc hospitalizations were related to atherosclerotic CVD (AS-CVD) as the primary discharge diagnosis. Furthermore, this study demonstrated that in-hospital mortality of SSc patients with CVD was significantly higher than SSc patients without CVD, and SLE and RA patients with CVD (21). Although interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are the leading causes of death in SSc, it is anticipated that as SSc survival improves with advances in treatment, CVD will further contribute to the mortality burden of SSc.…”

Carotid Intima Media Thickness in Systemic Sclerosis Patients: Results From a Single Centre, Cross Sectional, Case-Control Study

“…Interestingly, a recent cross-sectional analysis of a large United States hospitalization database [1993][1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007] estimated that approximately 5.4% of 308,452 SSc hospitalizations were associated with atherosclerotic CV disease as a primary discharge diagnosis. The same study also reported that SSc hospitalizations were more likely to result in death than similar hospitalizations of SLE and control patients [16].…”