Atherosclerotic Cardiovascular Disease in Hospitalized Patients With Systemic Sclerosis: Higher Mortality Than Patients With Lupus and Rheumatoid Arthritis
Article first published online: 28 JAN 2014
Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
Arthritis Care & Research
Volume 66, Issue 2, pages 323–327, February 2014
How to Cite
Dave, A. J., Fiorentino, D., Lingala, B., Krishnan, E. and Chung, L. (2014), Atherosclerotic Cardiovascular Disease in Hospitalized Patients With Systemic Sclerosis: Higher Mortality Than Patients With Lupus and Rheumatoid Arthritis. Arthritis Care Res, 66: 323–327. doi: 10.1002/acr.22152
- Issue published online: 28 JAN 2014
- Article first published online: 28 JAN 2014
- Accepted manuscript online: 10 SEP 2013 03:30PM EST
- Manuscript Accepted: 27 AUG 2013
- Manuscript Received: 22 FEB 2013
- Scleroderma Research Foundation
- Karen Brown Scleroderma Foundation
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.
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.
A total of 308,452 hospitalizations of SSc patients were included, of which 5.4% were associated with a primary ASCVD diagnosis or procedure. ASCVD-related SSc hospitalizations were more likely to result in death compared with non-ASCVD SSc hospitalizations (odds ratio [OR] 1.3, 95% confidence interval [95% CI] 1.1–1.4). Multivariate analyses showed that ASCVD-related SSc hospitalizations were more likely to result in death than similar hospitalizations of SLE (OR 1.5, 95% CI 1.2–1.8), RA (OR 2.3, 95% CI 1.9–2.8), and control patients (OR 1.4, 95% CI 1.2–1.8) with ASCVD.
SSc patients with ASCVD have higher in-hospital mortality than comparable groups of SLE and RA patients with ASCVD. Further research to elucidate the specific mechanisms underlying ASCVD in SSc is necessary.