A critical view on cardiovascular risk in systemic sclerosis

Abstract

Systemic Sclerosis (SSc) is an autoimmune disorder characterized by microvascular injury and diffuse fibrosis of the skin and internal organs. While macrovascular disease and higher risk for cardiovascular events are well documented in other systemic rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus, the presence and extent of atherosclerosis among patients with SSc is yet to be established. Primary cardiac involvement, due to impairment of coronary microvascular circulation and myocardial fibrosis, considerably affects prognosis and life expectancy of individuals with SSc, representing one of the leading causes of death in this population. On the other hand the existence and prevalence of atherosclerotic coronary disease remains an issue of debate as studies comparing structural and morphological markers of atherosclerosis and cardiovascular events between SSc patients and the general population have yielded controversial results. The aim of this review is to summarize recent literature about the prevalence of cardiovascular disease in SSc, review the surrogate markers of CVD that have been evaluated and examine whether common pathogenic mechanisms exist between SSc and macrovascular disease.

Lower-limb Ulcers in Systemic Sclerosis: A Multicentre Retrospective Case-control Study

“…Microangiopathic LLUs and LLUs associated with peripheral macrovascular involvement have also previously been reported as case reports or short series (8,11,(22)(23)(24)(25). Arterial macrovascular involvement in SSc may be secondary to multiple factors such as endothelial dysfunction, chronic inflammation, disease duration, and traditional cardiovascular risk factors (26)(27)(28)(29)(30)(31). In our study, ischaemic macrovascular LLUs with significant arterial involvement in arteriography accounted for 15% of LLUs, close to the 10.8% reported by Blagojevic et al and to the 10% to 20% of SSc patients reported as having symptomatic lower-limb peripheral arterial disease (11,28,32,33).…”

Cardiodermatology in the physician’s practice

“…Similarly to other systemic diseases of connective tissue, such as rheumatoid arthritis and systemic lupus erythematosus, systemic sclerosis is linked to an elevated cardiovascular risk [14]. An analysis of data from the Danish Register showed that 25% of deaths of patients with systemic sclerosis were due to cardiovascular causes including myocardial infarction, heart failure and stroke, and further 26% of deaths were associated with other vascular complications such as scleroderma renal crisis and pulmonary hypertension [15,16].…”

“…According to guidelines published by scientific societies, patients with systemic sclerosis require regular monitoring to detect possible involvement of the cardiovascular system [20]. Early initiation of rheological treatment with phosphodiesterase-5 inhibitors, prostaglandin analogues, calcium channel antagonists, and endothelin receptor antagonists may improve microcirculatory function, and slow down adverse changes occurring in the cardiovascular system [14].…”

“…Twardzina układowa, podobnie jak inne układowe choroby tkanki łącznej, takie jak reumatoidalne zapalenie stawów i toczeń rumieniowaty układowy, charakteryzuje się zwiększonym ryzykiem sercowo--naczyniowym [14]. Na podstawie analizy danych z duńskiego rejestru wykazano, że 25% zgonów pacjentów z twardziną układową wynika z przyczyn sercowo-naczyniowych, w tym zawału serca, niewydolności serca i udaru mózgu, a kolejne 26% zgonów wiąże się z innymi powikłaniami naczyniowymi, np.…”

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

“…Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by endothelial dysfunction, microvascular damage, in ammation, impaired coagulation/ brinolysis and increased tissue brosis [8], and enhanced cardiovascular risk [9]. SSc has been associated with a disrupted lipid pro le.…”