Excess Mortality From Atherosclerotic Cardiovascular Disease in Systemic Sclerosis Compared to Lupus and Rheumatoid Arthritis - ACR Meeting Abstracts

Abstract Number: 706

Excess Mortality From Atherosclerotic Cardiovascular Disease in Systemic Sclerosis Compared to Lupus and Rheumatoid Arthritis

Amish J. Dave¹, Bharathi Lingala², David Fiorentino³, Eswar Krishnan⁴ and Lorinda Chung⁵, ¹Stanford University, Stanford, CA, ²Dermatology, Stanford University, Redwood City, CA, ³Dermatology, Stanford University School of Medicine, Redwood City, CA, ⁴Medicine, Standford University, Palo Alto, CA, ⁵Rheumatology, Stanford Univ Medical Center, Palo Alto, CA

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Atherosclerosis, morbidity and mortality and scleroderma

Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s – Clinical Aspects and Therapeutics

Session Type: Abstract Submissions (ACR)

Background/Purpose: Patients with autoimmune connective tissue diseases (CTD), including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are at increased risk for atherosclerotic cardiovascular disease (ASCVD) compared with the general population. Recent reports indicate an increased prevalence of ASCVD in patients with systemic sclerosis (SSc), thought to be mediated through inflammatory mechanisms affecting vascular integrity, including endothelial cell damage and increased collagen deposition. Our aim was to utilize the Nationwide Inpatient Sample (NIS) to assess the prevalence of and mortality risk associated with ASCVD among hospitalized patients with SSc.

Methods: The NIS is a national, annual, representative survey of hospitalized patients in the US. We examined the in-hospital frequency and mortality rates of specific diagnoses and procedures associated with ASCVD among hospitalized adult patients with SSc using data from the NIS from 1993 to 2007. The following diagnoses and procedures were identified by ICD-9 codes: coronary artery disease, myocardial infarction, cerebrovascular accidents, coronary artery bypass grafts, and percutaneous transluminal coronary angioplasty. Analyses were weighted so results are standardized to the US population as a whole. Using logistic regression, we compared the odds of death among hospitalized SSc patients with each ASCVD diagnosis or procedure to patients with SLE or RA, and to a control group that excluded patients with any CTD diagnosis and were matched to cases by age, gender, and race. Multivariate analyses controlled for demographics, comorbid diseases using the Charlson comorbidity index, elective vs. emergent hospitalizations, and the number of diagnoses.

Results: A total of 308,452 hospitalizations of SSc patients occurred in the US between 1993 and 2007. The mean age was 61.5 years, 84% were female, and 59% were white. 12% of all SSc hospitalizations were associated with an ASCVD diagnosis or procedure, compared with 11% of SLE and 15% of RA hospitalizations. SSc hospitalizations associated with ASCVD were 1.5 times more likely to result in death compared with SSc hospitalizations not associated with ASCVD (OR 1.5, 95% CI 1.4-1.6, p<.001). Highest odds of in-hospital death were associated with CAD/MI (OR 1.7, 95% CI 1.6-2.0, p<.001) and CVA (OR 1.4, 95% CI 1.2-1.6, p<.001). Multivariate analyses showed that SSc hospitalizations associated with ASCVD were more likely to result in death than hospitalizations of SLE (OR 1.6, 95% CI 1.4-1.9, p<.001), RA (OR 2.6, 95% CI 2.3-3.0, p<.001), and control patients (OR 1.6, 95% CI 1.4-1.8, p<.001) with ASCVD.

Conclusion: Although the frequency of hospitalizations associated with ASCVD in SSc patients is similar to that in SLE and RA patients in the US, there is an increased risk of in-hospital death associated with SSc. Further studies are necessary to determine whether the underlying vasculopathy, which affects the micro- and macrovasculature in SSc patients, contributes to increased mortality associated with ASCVD.

Disclosure:

A. J. Dave,
None;

B. Lingala,
None;

D. Fiorentino,
None;

E. Krishnan,
None;

L. Chung,

Gilead and Actelion,

5,

Gilead, Actelion, Pfizer, United Therapeutics,

2.

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