Silent cardiovascular involvement in patients with diffuse systemic sclerosis: a controlled cross‐sectional study

Abstract

Objective. An association between systemic autoimmune diseases and atherosclerosis has been described in many connective tissue diseases, and this association is known to lead to increased cardiovascular morbidity and mortality. Systemic sclerosis (SSc) is characterized by multisystem organ inflammation, endothelial wall damage, and vasculopathy. There are many markers of endothelial dysfunction and/or atherosclerotic risk, such as asymmetric dimethylarginine (ADMA), arterial stiffness parameters, carotid intima-media thickness (CIMT), and coronary flow reserve (CFR) assessed by transthoracic echocardiography. The aim of this pilot study was to use various endothelial and atherosclerosis markers to identify early cardiovascular involvement in a group of SSc patients. Methods. The study involved 20 patients (2 men and 18 women with a mean ؎ SD age of 52.96 ؎ 12.51 years) with diffuse SSc who had no signs or symptoms of cardiovascular disease (CVD) and 20 age-and sex-matched controls. All subjects underwent a dipyridamole echocardiographic stress test that included a determination of CFR and an evaluation of CIMT, arterial stiffness, and plasma ADMA levels. Results. All of the arterial wall measurements of the patients with diffuse SSc were significantly different from those of the controls, and both right and left CIMT, pulse wave velocity, and stiffness index (␤) were significantly elevated in the SSc patients compared to the healthy controls. Moreover, in patients with diffuse SSc, CFR was significantly lower (P ‫؍‬ 0.0033) and plasma ADMA levels were higher (P < 0.0001) than in healthy controls. Conclusion. SSc patients without any clinical evidence of CVD seem to have had subclinical atherosclerosis, which was suggested by early impairment of coronary microcirculation and macrovascular involvement.

Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events

“…Coronary flow reserve was reported to be lower in diffuse cutaneous SSc patients [62], perhaps due to microvascular involvement rather than atherosclerosis [8]. In SSc patients of our cohort, atherosclerosis was also found more often in the limited than diffuse cutaneous subtype, hence centromere antibody was found more often and SCL70 antibody less often in patients with atherosclerotic plaque.…”

My Approach to the Treatment of Scleroderma

“…Reversible vasospasm of small coronary arteries and arterioles can occur that potentially causes ischemia reperfusion injury 110 . Although still controversial, there is epidemiological evidence for an increased risk of atherosclerotic coronary artery disease similar to that found in other rheumatic diseases 111–113 . All subtypes of scleroderma are at risk for significant heart disease but patients with rapidly evolving diffuse skin disease 114 , those with underlying skeletal muscle disease 61,115 and those with anti-U3RNP are prone to develop a severe cardiomyopathy.…”

Cardiovascular Involvement in Autoimmune Diseases

“…The vasculopathy of SSc typically affects the small arteries and capillaries (i.e., microvascular occlusive disease with vasospasm and intimal proliferation) while macrovascular disease has been demonstrated by carotid ultrasonography, ankle brachial blood pressure index, and peripheral angiography [48, 50, 52] due to fibrosis, thickening, and chronic proliferation of the intimal layer as well as transmural lymphocytic infiltrate without evidence of atherosclerotic plaque [48, 53]. However, recently, the evidence has demonstrated increased atherosclerosis, including CAC, higher prevalence of subclinical CAD, and higher carotid IMT [46, 212].…”