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Increased Risk of Acute Myocardial Infarction in Systemic Sclerosis: A Nationwide Population-based Study
Authors:Szu-Ying Chu  Yi-Ju Chen  Chia-Jen Liu  Wei-Cheng Tseng  Ming-Wei Lin  Chian-Yaw Hwang  Chih-Chiang Chen  Ding-Dar Lee  Tzeng-Ji Chen  Yun-Ting Chang  Wen-Jen Wang  Han-Nan Liu
Affiliation:1. Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan;2. Department of Dermatology, National Yang-Ming University, Taipei, Taiwan;3. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan;4. Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan;5. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;6. School of Medicine, National Yang-Ming University, Taipei, Taiwan;g Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;h Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan;i Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan;j Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;k Department of Dermatology, National Defense Medical Centre, Taipei, Taiwan
Abstract:

Purpose

Systemic sclerosis is a life-threatening autoimmune disease characterized by vasculopathy, which results in myocardial involvement in an extremely high percentage of patients. Nevertheless, there have been no large-scale epidemiological studies about the risk of acute myocardial infarction in patients with systemic sclerosis. The aims of this study were to evaluate the hazard ratio (HR) and risk factors of acute myocardial infarction in patients with systemic sclerosis, as well as to compare the risks of acute myocardial infarction among systemic sclerosis patients taking different immunosuppressors.

Methods

The study cohort included 1344 patients with systemic sclerosis and 13,440 (1:10) age-, sex-, and comorbidity-matched controls during the period between 1997 and 2006, from the National Health Insurance Research Database. We compared the risk of acute myocardial infarction between patients with systemic sclerosis and controls and calculated the adjusted HRs for acute myocardial infarction in systemic sclerosis patients taking immunosuppressors and not taking immunosuppressors.

Results

The incidence rates of acute myocardial infarction were 535 and 313 cases per 100,000 person-years for systemic sclerosis cohort and reference cohort, respectively (P <.001, unadjusted). After adjusting for age, sex, and underlying medical diseases on Cox proportional hazards model, systemic sclerosis was found to be an independent risk factor for acute myocardial infarction (HR 2.45). Other risk factors included hypertension (HR 2.08) and diabetes (HR 2.14). The multivariate adjusted HR for acute myocardial infarction did not decrease among the systemic sclerosis patients taking systemic steroids, penicillamine, cyclophosphamide, azathioprine, methotrexate, or cyclosporine.

Conclusion

Systemic sclerosis is independently associated with an increased risk of acute myocardial infarction. Immunosuppressors do not lower the risk of acute myocardial infarction in our study.
Keywords:Cardiovascular risk   Coronary artery disease   Immunosuppressor   Myocardial infarction   Systemic sclerosis
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