Systemic sclerosis & Raynaud's
Untangling the relationship between smoking and systemic sclerosis: an analysis of the EUSTAR cohort
Authors' conclusion
Our stratified analysis demonstrates that smoking is associated with an increased risk for mortality in male SSc patients but not in women. Strikingly, smoking is associated with lower prevalence of ATA positivity, in particular in women. In both ATA-positive and ACA-positive patients, smoking is a risk factor for mortality, skin progression and 'any organ progression'.
Study context
- Population
- Patients with SSc in the EUSTAR cohort10,393 women (84%)
- Participants
- 12,314 patients
- Exposure
- Ever-smokers vs never-smokers
- Ever-smokersn = 4,271
- Outcome
- Mortality in men (stratified by sex)
- Follow-up
- 15 years
Methodological detailsstratified for sex and ACA/anti-topoisomerase antibodies (ATA) positivity, Kaplan-Meier curves, Cox models, 15 years of follow-up
- Stratified for sex and ACA/ATA positivity
- Kaplan-Meier curves
- Cox models
- 15 years of follow-up
Main finding
As reported in the abstract
- Smoking associated with mortality in men, HR 1.63 (95% CI 1.23 to 2.16)
- p=0.001
Observational data: associations, not effects.
Further findings
ATA positivity in women
P < 0.001
Skin progression in women
- Ever-smoking women at higher risk, HR 1.10 (95% CI 1.00 to 1.22)
- P = 0.046
'Any organ progression' in women
- Ever-smoking women at higher risk, HR 1.07 (95% CI 1.00 to 1.13)
- P = 0.036
ATA frequency by smoking exposure among ever-smokers
- Pack-years, OR 0.98 (95% CI 0.97 to 0.99); higher exposure associated with lower ATA frequency
- P < 0.001
- Smoking duration, OR 0.96 (95% CI 0.95 to 0.97); higher exposure associated with lower ATA frequency
- P < 0.001
Outcomes in ACA-positive patients, smokers
- Mortality, HR 1.29 (95% CI 1.02 to 1.63)
- P = 0.033
- Cardiac involvement, HR 1.25 (95% CI 1.03 to 1.43)
- P = 0.001
- Skin progression, HR 1.21 (95% CI 1.03 to 1.42)
- P = 0.018
- 'Any organ progression', HR 1.14 (95% CI 1.05 to 1.24)
- P = 0.002
Outcomes in ATA-positive patients, smokers
- Mortality, HR 1.40 (95% CI 1.10 to 1.78)
- P = 0.006
- Skin progression, HR 1.19 (95% CI 1.03 to 1.37)
- P = 0.020
- Digital ulcers, HR 1.17 (95% CI 1.02 to 1.34)
- P = 0.029
- 'Any organ progression', HR 1.11 (95% CI 1.00 to 1.22)
- P = 0.048
Original publication
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