Cardiovascular Risk in Myositis Patients Compared to the General Population: Preliminary Data From a Single-Center Cross-Sectional Study

Abstract

BackgroundIdiopathic inflammatory myopathies (IIM) are associated with systemic inflammation, limited mobility, and glucocorticoid therapy, all of which can lead to metabolism disturbances, atherogenesis, and increased cardiovascular (CV) risk. The aim of this study was to assess the CV risk in IIM patients and healthy controls (HC), and its association with disease-specific features.MethodsThirty nine patients with IIM (32 females; mean age 56; mean disease duration 4.8 years; dermatomyositis: n = 16, polymyositis: n = 7, immune-mediated necrotizing myopathy: n = 8, anti-synthetase syndrome: n = 8) and 39 age-/sex-matched HC (32 females, mean age 56) without rheumatic diseases were included. In both groups, subjects with a history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events) were excluded. Muscle involvement, disease activity, and tissue damage were evaluated (Manual Muscle Test-8, Myositis Intention to Treat Activity Index, Myositis Damage Index). Comorbidities and current treatment were recorded. All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (by densitometry and bioelectric impedance). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE, charts for the European population) and its modifications.ResultsCompared to HC, there was no significant difference in IIM patients regarding blood pressure, ABI, PWV, CIMT, and the risk of fatal CV events by SCORE or SCORE2, or subclinical atherosclerosis (CIMT, carotid plaques, ABI, and PWV). The calculated CV risk scores by SCORE, SCORE2, and SCORE multiplied by the coefficient 1.5 (mSCORE) were reclassified according to the results of carotid plaque presence and CIMT; however, none of them was demonstrated to be significantly more accurate. Other significant predictors of CV risk in IIM patients included age, disease duration and activity, systemic inflammation, lipid profile, lean body mass, and blood pressure.ConclusionsNo significant differences in CV risk factors between our IIM patients and HC were observed. However, in IIM, CV risk was associated with age, disease duration, duration of glucocorticoid therapy, lipid profile, and body composition. None of the currently available scoring tools (SCORE, SCORE2, mSCORE) used in this study seems more accurate in estimating CV risk in IIM.

Cardiovascular risk in myositis patients compared with the general population

“…All of the individuals were divided into four categories to assess the overall CV risk, based on the level of risk calculated by (i) SCORE (CVR-SCORE), (ii) SCORE2 (CVR-SCORE2), (iii) mSCORE (CVR-mSCORE), and (iv) carotid ultrasound findings including CIMT, presence of carotid plaques and plaque thickness (CVR-US), in the same manner as in our previously published cohorts [ 26 ]. Each category consisted of three risk strata as described in Supplementary Table S1 , available at Rheumatology online.…”

“…Body composition was measured by two methods: bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). Further details on the devices used and measurements and parameters have been described elsewhere [ 25 , 26 ].…”

“…CV risk was evaluated as described in our preliminary study [ 26 ]. In all participants, we applied the SCORE system [ 17 ] according to the European population chart, and the SCORE2 system [ 18 ] using the online calculator ( https://u-prevent.nl/calculators ) for the high-risk population (Czech Republic).…”

“…The selected non-invasive examination methods were performed in all participants: ultrasound examination of carotid arteries to evaluate the carotid intima–media thickness (CIMT) [ 27 ] and the presence of plaques (carotid artery disease [CARD]) [ 28 ], pulse wave velocity (PWV) [ 29 ] by two trained cardiologists (one for CIMT, one for PWV), and ankle-brachial index (ABI) [ 30 ] by an experienced cardiology nurse, all of whom were blinded to the group allocation. Further details were described elsewhere [ 26 ].…”

“…We assessed the overall CV risk as described previously [ 26 ]. All participants were divided into three categories: low, intermediate and high risk.…”