{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T11:38:06Z","timestamp":1775475486780,"version":"3.50.1"},"reference-count":32,"publisher":"The Journal of Rheumatology","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>Previously thought to involve primarily the microvasculature, systemic sclerosis (SSc) has been increasingly linked to macrovascular disease. Cardiovascular (CV) and cerebrovascular disease are responsible for 20\u201330% of mortality in SSc, but few studies have shown an independent association between SSc and stroke. We assessed whether SSc was an independent risk factor for ischemic stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>We conducted a retrospective cohort study using the national Veterans Affairs (VA) administrative database containing records from 1999 to 2014. We obtained data for all patients with a diagnosis of SSc as well as 2 controls per SSc patient matched on sex, race, smoking status, and VA site. All patients were followed until development of ischemic stroke, death, or last encounter. We used a Cox proportional hazard regression model to estimate risk of ischemic stroke, with adjustments for CV comorbidities (hypertension, diabetes, atrial fibrillation, non-cerebrovascular atherosclerotic disease, hyperlipidemia), baseline medication use (aspirin, nonsteroidal antiinflammatory drugs), and Medicare enrollment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Among 4545 individuals with SSc (83% male, mean age 60.9 yrs), the incidence rate of ischemic stroke was 15.3 per 1000 person-years (vs 12.2 in the control cohort), with an unadjusted HR 1.28 (95% CI 1.11\u20131.47). The adjusted HR was 1.21 (95% CI 1.05\u20131.40) after adjusting for baseline CV risk factors, medications, and Medicare enrollment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>SSc is independently associated with a higher risk of ischemic stroke among US veterans. Patients with SSc represent a population likely to benefit from targeted stroke screening or prevention therapies.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.181311","type":"journal-article","created":{"date-parts":[[2019,3,15]],"date-time":"2019-03-15T17:06:04Z","timestamp":1552669564000},"page":"82-88","source":"Crossref","is-referenced-by-count":21,"title":["Increased Risk of Ischemic Stroke in Systemic Sclerosis: A National Cohort Study of US Veterans"],"prefix":"10.3899","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2893-9146","authenticated-orcid":false,"given":"David","family":"Ying","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8351-4626","authenticated-orcid":false,"given":"Milena A.","family":"Gianfrancesco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4046-200X","authenticated-orcid":false,"given":"Laura","family":"Trupin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-4094","authenticated-orcid":false,"given":"Jinoos","family":"Yazdany","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3473-3846","authenticated-orcid":false,"given":"Eric L.","family":"Greidinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-5043","authenticated-orcid":false,"given":"Gabriela","family":"Schmajuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2262","published-online":{"date-parts":[[2019,3,15]]},"reference":[{"key":"2022092307201003000_47.1.82.1","first-page":"1325","article-title":"Mechanisms of endothelial cell damage in systemic sclerosis and Raynaud\u2019s phenomenon","volume":"20","author":"Blann","year":"1993","journal-title":"J Rheumatol"},{"key":"2022092307201003000_47.1.82.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.50.Suppl_4.866"},{"key":"2022092307201003000_47.1.82.3","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ken280"},{"key":"2022092307201003000_47.1.82.4","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ken078"},{"key":"2022092307201003000_47.1.82.5","doi-asserted-by":"publisher","DOI":"10.1002\/art.30380"},{"key":"2022092307201003000_47.1.82.6","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.109.198424"},{"key":"2022092307201003000_47.1.82.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202007"},{"key":"2022092307201003000_47.1.82.8","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes352"},{"key":"2022092307201003000_47.1.82.9","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.amjmed.2013.06.025","article-title":"Increased risk of acute myocardial infarction in systemic sclerosis: a nationwide population-based study","volume":"126","author":"Chu","year":"2013","journal-title":"Am J Med"},{"key":"2022092307201003000_47.1.82.10","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-201176"},{"key":"2022092307201003000_47.1.82.11","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.amjmed.2015.10.037","article-title":"Early cardiovascular disease after the diagnosis of systemic sclerosis","volume":"129","author":"Avi\u00f1a-Zubieta","year":"2016","journal-title":"Am J Med"},{"key":"2022092307201003000_47.1.82.12","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3109\/14397595.2015.1056931","article-title":"Risk of ischemic stroke in patients with systemic sclerosis: a systematic review and meta-analysis","volume":"26","author":"Ungprasert","year":"2016","journal-title":"Mod Rheumatol"},{"key":"2022092307201003000_47.1.82.13","unstructured":"U.S. Department of Veterans Affairs . 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