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Systemic sclerosis is an independent risk factor for ischemic heart disease, especially in patients carrying certain antiphospholipid antibodies: A large cross-sectional study

  • Abdulla Watad
    Correspondence
    Corresponding author at: Department of Medicine 'B' and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer 5262100, Israel.
    Affiliations
    Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel

    Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Israel

    Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
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  • Dennis McGonagle
    Affiliations
    Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
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  • Nicola L. Bragazzi
    Affiliations
    Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Canada
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  • Giovanni Damiani
    Affiliations
    Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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  • Doron Comaneshter
    Affiliations
    Chief Physician's Office, Faculty of Health Sciences, Clalit Health Services Tel Aviv, Israel
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  • Merav Lidar
    Affiliations
    Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Israel
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  • Arnon D. Cohen
    Affiliations
    Chief Physician's Office, Faculty of Health Sciences, Clalit Health Services Tel Aviv, Israel

    Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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  • Howard Amital
    Affiliations
    Department of Medicine ‘B’, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel

    Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Israel
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      Highlights

      • Systemic sclerosis (SSc) is an independent risk factor for ischemic heart disease (IHD).
      • SSc-linked autoantibodies have no impact on the risk of IHD.
      • SSc patients with positive anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) exhibited a higher risk of IHD than SSc patients without these antibodies.

      Abstract

      Background

      A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis (SSc) was reported. However, contrasting findings were published concerning the role of SSc-related autoantibodies in IHD risk which remains controversial. The current study explored the link between SSc and IHD, impact of putative links on SSc mortality and the role of SSc-related and antiphospholipid autoantibodies in disease associated IHD.

      Methods

      A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted on 2431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD was compared between patients diagnosed with SSc and age- and gender-matched controls. The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD was assessed.

      Results

      The prevalence rate of IHD was significantly higher in SSc than controls (20.4% vs 15.0%, p <0.001). At the multivariate analysis, SSc was an independent predictor of IHD with an OR of 1.91 (95%CI 1.57–2.31, p < 0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI 2.03–3.53, p < 0.0001) than those without IHD. In SSc patients positivity for anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) represented a risk factor for IHD with an OR 1.89 (95% 1.04–3.45, p = 0.0369) and OR of 3.72 (95% 1.25–11.11, p = 0.0184), respectively.

      Conclusions

      Patients with SSc are at higher risk for developing IHD with an additional risk for the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion is needed during routine patient follow-up and pre-emptive screening should be considered.

      Keywords

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