title: Early Cardiovascular Disease After the Diagnosis of Systemic Sclerosis.
abstract: OBJECTIVE
  The purpose of this study is to assess risk and time trends of newly recorded myocardial infarction and stroke in cases with systemic sclerosis.
  
  
  METHODS
  We conducted a matched incident cohort study (1996-2010) among patients satisfying at least one of the following: 1) diagnosis of systemic sclerosis on at least 2 visits within a 2-year period by a nonrheumatologist physician; or 2) diagnosis of systemic sclerosis on at least one visit by a rheumatologist or from hospitalization; as well as receiving no prior systemic sclerosis diagnosis between 1990 and 1995. Ten controls were matched by birth year, sex, and calendar year of exposure from the general population for each case. Incident myocardial infarction, stroke, and myocardial infarction or stroke was recorded from hospital or death certificates. We estimated incidence rate ratios and hazard ratios (HRs) after adjusting for confounders.
  
  
  RESULTS
  Among 1239 individuals with systemic sclerosis and no history of myocardial infarction (83% female, 56 years old), the incidence rate for myocardial infarction was 13.0/1000 person-years vs 4.1/1000 person-years in the comparison cohort. The incidence rate for stroke was 8.0/1000 person-years vs 3.7/1000 among controls. The adjusted HRs were 3.49 (95% confidence interval [CI], 2.52-4.83) and 2.35 (95% CI, 1.59-3.48) for myocardial infarction and stroke, respectively. For myocardial infarction and stroke, the risk was highest within the first year following diagnosis (HR 8.95; 95% CI, 5.43-14.74 and HR 5.25; 95% CI, 2.90-9.53, respectively).
  
  
  CONCLUSIONS
  This large general population-based study indicates an increased risk of myocardial infarction and stroke in patients with systemic sclerosis, especially within the first year of diagnosis.
authors.affiliation: Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: azubieta@arthritisresearch.ca.
authors.forename: J Antonio
authors.initials: JA
authors.lastname: Aviña-Zubieta
authors.affiliation: Section of Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: Ada
authors.initials: A
authors.lastname: Man
authors.affiliation: Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Marko
authors.initials: M
authors.lastname: Yurkovich
authors.affiliation: Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Kun
authors.initials: K
authors.lastname: Huang
authors.affiliation: Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Sayre
authors.affiliation: Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; Department of Rheumatology, Division of Rheumatology, Allergy and Immunology, Harvard Medical School, Boston, Mass.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012306:Risk; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*
keywords: Acute myocardial infarction; Cardiovascular disease; Risk; Stroke; Systemic sclerosis