Subclinical Atherosclerosis in Systemic Sclerosis: Not Less Frequent Than Rheumatoid Arthritis and Not Detected With Cardiovascular Risk Indices

Abstract

ObjectiveTo determine the frequency of subclinical atherosclerosis in patients with systemic sclerosis (SSc; scleroderma) compared to healthy subjects (HS) and rheumatoid arthritis (RA) patients and to determine the ability of cardiovascular (CV) risk indices in detecting SSc patients with subclinical atherosclerosis.MethodsA total of 110 SSc patients (102 females and 8 males, mean ± SD age 50.5 ± 11.9 years), 110 age‐ and sex‐matched RA patients, and 51 HS without CV disease were examined with ultrasonography (US). Carotid intima‐media thickness (cIMT) >0.90 mm and/or carotid plaques were used as the gold standard for subclinical atherosclerosis (US+). Systematic Coronary Risk Evaluation (SCORE), QRisk II, and 2013 American College of Cardiology (ACC)/American Heart Association (AHA) CV risk indices were calculated.ResultsTwenty‐one (19.1%) SSc patients, 24 (21.8%) RA patients, and 3 (5.9%) HS had subclinical atherosclerosis (SSc versus RA: P = 0.62, SSc versus HS: P = 0.029). cIMT in SSc was higher compared to HS (0.68 ± 0.15 mm versus 0.61 ± 0.10 mm; P = 0.008) but similar to RA patients (0.66 ± 0.14 mm; P = 0.82). Subclinical atherosclerosis in SSc was associated with age (odds ratio [OR] 1.07, P = 0.013), elevated erythrocyte sedimentation rate (OR 3.4, P = 0.045), and pulmonary arterial hypertension (OR 4.27, P = 0.012). Concerning CV risk indices, of the 21 US+ SSc patients only 0, 3 (14.2%), and 6 (28.6%) were classified as high CV risk according to SCORE, QRisk II, and ACC/AHA risk indices, respectively.ConclusionSubclinical atherosclerosis in SSc patients is more frequent than in HS, but is as frequent as in RA patients in which accelerated atherosclerosis is clearly defined. CV risk indices for the general population are considerably insufficient to detect SSc patients with atherosclerosis.

Ultrasonography involvement of carotid, upper and lower limb arteries in a large cohort of systemic sclerosis patients

“…In our cohort we found that carotid and LL involvement is quite common and that, in multivariate analysis, traditional CRF are important determinants of proximal LL atherosclerosis with a trend for carotid and distal LL involvement. Similar results, although with a less complete evaluation of traditional CRF, have been reported in other studies 11,19,20 . Traditional CRF may play a role in macrovasculopathy, especially at proximal LLs, also in SSc, so the rheumatologist should always assess cardiovascular risk in these patients in order to prevent the development of its possible complications.…”

“…ACAs are a well‐known risk factor for PAH but no analysis on this were reported probably because of the small number of patients with both or either of these characteristics. In addition, Ozen et al 19 have recently found that PAH was more common in patients with increased cIMT, further supporting a possible link between micro‐ and macrovasculopathy via a common pathologic pathway such as endothelial dysfunction 25,26 . Although these data support an intriguing link between micro‐ and macrovasculopathy, there is contrasting evidence on videocapillaroscopy.…”

“…There is strong evidence that inflammation increases the risk of atherosclerosis not only in the general population, 22 but also in SSc patients 18 . In particular, Ozen et al 19 and Sedky et al 20 have recently found an increase in ESR in SSc patients with subclinical atherosclerosis. Although ESR is more variable than CRP in assessing inflammation and may be affected by many factors, such as age and gender, our result was confirmed also after correcting for them, so its increase in vasculopathy patients may be actually related to the role of inflammation in atherosclerosis.…”

HDL-Cholesterol Efflux Capacity and Lipid Profile in Patients With Systemic Sclerosis

“…However, it has been assessed, in others connective tissue diseases like RA and SLE. Compared to RA patients, SSc patients appear to share a similar burden of subclinical atherosclerosis and cardiovascular comorbidities [24,25]. In a previous report by our group including 178 RA patients and 223 sex-matched control subjects, CEC was not signi cantly different between them, although patients exhibiting higher disease activity had lower levels of CEC than patients in remission.…”

Cardiovascular complications of systemic sclerosis: What to look for

“…51,53,[55][56][57][58] A meta-analysis found that the carotid intima and media are signifi cantly thicker in systemic sclerosis patients than in controls, 59 and the magnitude of difference is similar to that in other groups at increased cardiovascular risk, such as those with rheumatoid arthritis, diabetes, and familial hypercholesterolemia. [60][61][62][63] A meta-analysis of brachial artery fi ndings showed signifi cantly lower fl ow-mediated dilation in systemic sclerosis patients than in controls. 64 Overall, given the inconsistency of study results, systemic sclerosis patients should be screened and managed as in other patients with peripheral artery disease, but the clinician should be aware that there may be a higher risk of peripheral artery disease in these patients.…”