RT Journal Article
SR Electronic
T1 A gender gap in primary and secondary heart dysfunctions in systemic sclerosis: a EUSTAR prospective study
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 163
OP 169
DO 10.1136/annrheumdis-2014-206386
VO 75
IS 1
A1 Elhai, Muriel
A1 Avouac, Jérôme
A1 Walker, Ulrich A
A1 Matucci-Cerinic, Marco
A1 Riemekasten, Gabriela
A1 Airò, Paolo
A1 Hachulla, Eric
A1 Valentini, Gabriele
A1 Carreira, Patricia E
A1 Cozzi, Franco
A1 Balbir Gurman, Alexandra
A1 Braun-Moscovici, Yolanda
A1 Damjanov, Nemanja
A1 Ananieva, Lidia P
A1 Scorza, Raffaella
A1 Jimenez, Sergio
A1 Busquets, Joanna
A1 Li, Mengtao
A1 Müller-Ladner, Ulf
A1 Kahan, André
A1 Distler, Oliver
A1 Allanore, Yannick
A1 ,
YR 2016
UL http://ard.bmj.com/content/75/1/163.abstract
AB Objectives In agreement with other autoimmune diseases, systemic sclerosis (SSc) is associated with a strong sex bias. However, unlike lupus, the effects of sex on disease phenotype and prognosis are poorly known. Therefore, we aimed to determine sex effects on outcomes.Method We performed a prospective observational study using the latest 2013 data extract from the EULAR scleroderma trials and research (EUSTAR) cohort. We looked at (i) sex influence on disease characteristics at baseline and (ii) then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival.Results 9182 patients with SSc were available (1321 men) for the baseline analyses. In multivariate analysis, male sex was independently associated with a higher risk of diffuse cutaneous subtype (OR: 1.68, (1.45 to 1.94); p<0.001), a higher frequency of digital ulcers (OR: 1.28 (1.11 to 1.47); p<0.001) and pulmonary hypertension (OR: 3.01 (1.47 to 6.20); p<0.003). In the longitudinal analysis (n=4499), after a mean follow-up of 4.9 (±2.7) years, male sex was predictive of new onset of pulmonary hypertension (HR: 2.66 (1.32 to 5.36); p=0.006) and heart failure (HR: 2.22 (1.06 to 4.63); p=0.035). 908 deaths were recorded, male sex predicted deaths of all origins (HR: 1.48 (1.19 to 1.84); p<0.001), but did not significantly account for SSc-related deaths.Conclusions Although more common in women, SSc appears as strikingly more severe in men. Our results obtained through the largest worldwide database demonstrate a higher risk of severe cardiovascular involvement in men. These results raise the point of including sex in the management and the decision-making process.