Angiographically proven coronary artery disease in scleroderma

Akram, Mohammed; Handler, Clive; Williams, Mark; Carulli, Maria Teresa; Andron, Mohammed; Black, Carol M.; Denton, Christopher P.; Coghlan, J. Gerry

doi:10.1093/rheumatology/kel120

Cited by 82 publications

(48 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Increased frequency of coronary artery calcification in SSc patients compared to controls has also recently been reported in a pilot study of smaller sample size (27), despite the similar or lower rate of CAD in SSc patients compared with controls demonstrated by some studies (13,15). Although myocardial insufficiency in SSc has been attributed to microvascular disease (28) and imbalanced hemostasis (29) in earlier studies, coronary atherosclerosis has been increasingly revealed by conventional coronary angiography in SSc patients (13,14), concomitant with the significantly improved survival of these patients over the past decades (30). Other macrovascular diseases, such as peripheral vascular disease, have also been frequently reported in SSc patients (31,32).…”

Section: Discussionmentioning

confidence: 73%

“…Studies published a few decades ago suggested an underlying microvascular disease of the myocardium, based on normal findings on coronary angiogram (8) and the absence of coronary atherosclerosis upon histologic examination at autopsy (9)(10)(11)(12). However, clinical and subclinical coronary artery disease (CAD) is increasingly reported in SSc patients (13)(14)(15), although the prevalence of coronary atherosclerosis and the predisposing factors in SSc patients remain unknown.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Mok¹,

Lau²,

Chiu³

et al. 2011

Arthritis & Rheumatism

View full text Add to dashboard Cite

Objective. Endothelial dysfunction and inflammation are pathogenic mechanisms common to systemic sclerosis (SSc) and atherosclerosis. This study was undertaken to examine the relationship between coronary atherosclerosis, as assessed by the coronary artery calcium score (CACS), and conventional cardiovascular and disease-specific risk factors in SSc patients.Methods. The CACS was measured by computed tomography, and cardiovascular risk factors were examined in SSc patients and compared with controls matched for age, sex, and glycemic status. Disease activity score, antiphospholipid antibodies, highsensitivity C-reactive protein level, and erythrocyte sedimentation rate were measured in SSc patients. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined.Results. We recruited 53 SSc patients (50 women and 3 men) and 106 controls. The patients had a mean ؎ SD age of 53.1 ؎ 12.9 years and a median disease duration of 9 years. Compared to controls, SSc patients had significantly lower low-density lipoprotein (LDL) cholesterol levels (P ‫؍‬ 0.001), high-density lipoprotein cholesterol levels (P ‫؍‬ 0.01), diastolic blood pressure, waist circumference, and body mass index and were more likely to be receiving vasodilators (all P < 0.001). There was a significantly higher proportion of SSc patients among subjects with more severe coronary calcification (CACS >101) compared to those with lesser severity (CACS <100) (56.5% versus 29.4%; P ‫؍‬ 0.01). Multiple logistic regression analysis revealed SSc to be an independent determinant for a CACS >101 (OR 10.89 [95% CI 2.21-53.75], P ‫؍‬ 0.003) together with age and LDL cholesterol level after adjustment for other cardiovascular risk factors. Among diseasespecific factors, only disease duration (OR 1.14 [95% CI 1.02-1.27], P ‫؍‬ 0.02) was independently associated with more severe coronary calcification (CACS >101).Conclusion. Our findings indicate that SSc is an independent risk factor for coronary calcification, in addition to the conventional risk factors for coronary atherosclerosis, such as age and hypertension.

show abstract

Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Mok¹,

Lau²,

Chiu³

et al. 2011

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…88 -90 Furthermore, a recent angiographic study of 172 systemic sclerosis patients with suspected coronary artery disease (based on the presence of angina or exertional dyspnea) detected rates of epicardial coronary disease similar to those in a comparison population with similar symptoms, age, and gender. 91 Further support for the existence of microvascular disease, particularly spasm, derives from the demonstration of improvement in myocardial perfusion with oral nifedipine therapy 89,92 and the detection of cold-induced perfusion defects and wall motion abnormalities 93 in systemic sclerosis patients with Raynaud's phenomenon. The presence of endothelial damage is supported by the presence of markedly increased numbers of circulating endothelial cells that, in turn, were related to an index of disease activity.…”

Section: Myocardial and Coronary Vascular Diseasementioning

confidence: 99%

Cardiovascular Manifestations of Rheumatologic Diseases

2007

View full text Add to dashboard Cite

“…Coronary vessel involvement has been ascertained invasively by coronarography in a few small studies (4,5), and also by simpler noninvasive methods, such as transthoracic echocardiography and the evaluation of coronary flow reserve (CFR). A number of studies have established the usefulness of CFR in the detection of coronary macrocirculation and microcirculation disorders in systemic autoimmune diseases (SADs) (6,7), and many classic and novel cardiovascular (CV) indices have been formulated for the detection of subclinical atherosclerosis, including carotid intima-media thickness (CIMT) (8,9).…”

Section: Introductionmentioning

confidence: 99%

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

Turiel¹,

Gianturco²,

Ricci³

et al. 2013

Arthritis Care & Research

View full text Add to dashboard Cite

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.

show abstract

Angiographically proven coronary artery disease in scleroderma

Abstract: The prevalence of CAD in patients with SSc is similar and not greater to that expected in individuals without SSc.

Cited by 82 publications

References 13 publications

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Cardiovascular Manifestations of Rheumatologic Diseases

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

Contact Info

Product

Resources

About