Objective: To assess the prevalence of subclinical atherosclerosis in patients with primary Sjögren's syndrome (pSS) and its possible association with clinical and analytical parameters of the disease. Methods: In this cross-sectional study, 38 consecutive patients with pSS were compared with 38 age and sex healthy controls. Demographic variables and classic cardiovascular risk factors (CVRFs): Hypertension, dyslipidemia, diabetes mellitus, obesity, and smoking habit were assessed in both groups, and also disease-related features were collected in pSS group. The presence of subclinical atherosclerosis was assessed by carotid ultrasound, with carotid intima-media thickness (CIMT) measurement and determination of the presence of atheromatous plaques. Results: Subclinical atherosclerosis presence was remarkably greater in patients with pSS than in healthy controls (OR = 4.17, 95%CI [1.27-16.54]), as well as CIMT values (0.79 ± 0.43 mm vs. 0.66 ± 0.27 mm; P = .02). No differences for classic CVRFs were found between both groups. An association of subclinical atherosclerosis with erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) was observed in patients with pSS. Conclusion: This cohort showed a greater prevalence of subclinical atherosclerosis in patients with pSS, indicating this disease as an independent risk factor for presence of early vascular damage.
Background:Some autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), are considered to be independent risk factors for vascular morbidity and mortality. These pathologies present accelerated atherosclerosis, partly because of a chronic sustained inflammation, greater prevalence of cardiovascular risk factors (CVRFs) and pharmacological therapy. However, regarding primary Sjögren’s syndrome (pSS), available data are heterogeneous and proceed from small case series. For this reason, the aim of this study was to provide further information on the identification of atherosclerosis in pSS and its possible association with clinical and analytical parameters of the disease.Objectives:To assess presence of subclinical atherosclerosis by means of carotid ultrasound in patients with pSS and to analyze clinical, analytical and CVRF along with their potential association with the presence of subclinical cardiovascular affectation.Methods:This is a cross-sectional study of 38 patients with pSS (all patients met ACR/EULAR1classification criteria for pSS) and 38 age and sex matched controls. Demographic variables and classical CVRFs were collected (Hypertension, Diabetes mellitus, dyslipemia, Body Mass Index and smoking habit) and the presence of subclinical atherosclerosis was assessed by carotid ultrasound with carotid intima-media thickness (CIMT) measurement and determination of the presence of atheromatous plaques2, both in pSS patients and controls. Disease features were also collected in pSS patients (disease duration, disease activity measured by ESSDAI, glandular vs extraglandular involvement, serological features and treatments received).Statistical analysis: To evaluate differences between patients and controls, T-test or Wilcoxon test with continuity correction, were used for quantitative features and Fisher test for categorical variables. In order to test the presence of pSS as an independent risk factor for subclinical atherosclerosis, from other features as classic CVRFs or analytical data, first we adjusted logistic binomial regression in a bivariate analysis, to select possible predictors to be included in a multivariate analysis. Statistical significance was p<0.05, and OR CI 95% vas calculated.R-Statistics v- 3.6Table 1.Comparison of clinical data of two case groups and healthy control group M (p25, p75)GroupsCase group ACase group BHealthy control groupH valueP valueHistory of thrombus (case)4a8a-13.7090.001History of adverse pregnancy (case)3a19a-34.596<0.001ESR20.00(12.25,111.00)a35.00(14.25,95.00)a9.00(6.00,13.00)34.381<0.001CRP15.00(4.03,37.83)ab7.33(1.76,21.13)ab2.10(1.28,2.31)35.263<0.001PLT228.00(189.50,573.25)ab197.00(66.00,260.50)ab258.50(228.25,272.25)33.482<0.001Note:aComparison with healthy control groupP< 0.05;bComparison with case groupP<0.05.Table 2.Comparison of lymphocyte subsets in peripheral blood of two case groups and healthy control group M (p25, p75)Results:All of the 76 patients included were women, with a mean age of 53.7 ± 11.7 years. For both groups, no differences between prevalence of classical CVRFs were found. Subclinical atherosclerosis presence was higher in patients with pSS than in controls [OR= 4.17, 95%CI (1.27- 16.54), p<0.001], as well as CIMT values (0.79± 0.43 mm vs. 0.66 ± 0.27 mm; p=0.02). An association of subclinical atherosclerosis with erythrocyte sedimentation rate [OR=1.18, 95%CI (1.05-1.37), p<0.05] and Rheumatoid Factor [OR=1.28, 95%CI (1.63-2.26), p<0.05].Conclusion:This cohort showed a greater prevalence of subclinical atherosclerosis in patients with pSS, indicating this disease as an independent risk factor for presence of early vascular damage.References:[1]Vitali C et al. Classification Criteria for Sjögren Syndrome: a revised version of the European criteria proposed by the American-European Consensous Group. Ann Rheum Dis. 2002; 61: 554-8[2]Touboul PJ et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012; 34: 290-6Disclosure of Interests:Marta Novella-Navarro: None declared, José Luis Cabrera-Alarcón: None declared, José Luis Rosales Grant/research support from: I have received financial support from Novartis, UCB, Pfizer, Abvie to meeting and symposia, Jorge Juan González Martin Grant/research support from: I have received finacial grants from Novartis, Lilly, Pfizer, Abvie for meetings and symposia assistance, Paloma García de la Peña Grant/research support from: I have received finacial grants from Novartis, Lilly, Pfizer, Abvie for meetings and symposia assistance, Ofelia Carrion: None declared
ObjectivesTo study whether patients with systemic sclerosis (SSc) have an increased cardiovascular risk (CVR), measured on the basis of analytical, angiodinamic and/or vascular lesions on carotid ultrasound.The carotid IMT is a marker of cardiovascular morbidity and mortality, allowing measurement and monitoring of atherosclerosis in asymptomatic individuals, being surrogate markers of future coronary disease, stroke and general death in the general population and in inflammatory rheumatologic diseases.MethodsEpidemiological and analytical data were collected, including the determination of the RCV SCORE index.Vascular ultrasound protocol included assessment of carotid intima-media thickness (IMT), presence of atheromatous plaques, and exploration of peripheral arteriopathy using the ankle arm index (ABI).ResultsSeventy adult patients with ES diagnosis (ACR-EULAT 2013 criteria) were included.94% of the women had a mean age of 50.2±12.5 years, and an average evolution time of 3.0±4.4 years.The distribution by subgroups was: limited SSc (48%), diffuse SSc (34%), pre-SSc (4'2%), sine SSc (2.8%), MCTD (5'7%) and overlap syndrome 4'2%). The mean SSRm was 9.3±7.0 (range 0–42).The ANA were positive in 91.4%, ACA (51.4%), ATA (10%), RNA polymerase (4'2%).4% were DM, 7% were obese, 11% were active smokers, 13% were HTN, and 28% were ex-smokers.28% had hypercholesterolemia with a mean total cholesterol of 192.5 (SD ± 31.9) and LDL of 102.4 (SD ± 29.4 mg/dL).57% received vasodilators, most of them ARA-II. 10% bosentan, 4.2% sildenafil, and a 2.8% combination therapy.The percentage of immunosuppressive drugs was corticoid (50%), MTX (34%), mycophenolate (3%), AZA (11%), HCQ (14%), CP %).The IMT presented pathological values (>0.9 mm) in 39% of the sample, 23% had atheroma plaques (being bilateral in 40%). Subclinical atheromatosis affected 41.4% (patients without cardiovascular events, pathological IMT and/or atheroma plaques). The ABI had pathological values (<0.9) in 17% of the patients.In the bivariate analysis, the pathological GIM was related to the presence of ACA antibodies (OR =3.80, 95% CI: 1.15–12.52, p=0.028) and with the SCORE index of CVR (OR =2.93, 95% CI: 1.12–7, 64, p=0.028); And the presence of atherosclerotic plaques was associated with increased SSRm score (OR 1.09, 95% CI 1.00–1.19, p=0.046), and the highest CVR SCORE index (OR 3.90, 95% CI: 1.31–11.56, p=0.014.In the multivariate analysis, the serum vitamin D concentration showed a protective effect on IMT (OR =0.94, 95% CI 0.89–0.99, p value =0.025); And the main determinant of atheromatous plaques is the SCORE index, since the increase of one unit in SCORE index multiplies by 4 the probability of presenting plaques (OR =4.06, 95% CI: 1.31–12.60; P=0.015), once the effect of SSRm was controlled.Conclusions 40% of the patients had pathological IMT values, showing association with the presence of positive AAC and the SCORE risk index.The serum concentration of 25-OH-vitamin D showed a protective effect on IMT. Sixty percent of the sample had vitamin D defi...
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