Ischemic arterial events and atherosclerosis in patients with systemic sclerosis: a population-based case-control study

Abstract

IntroductionWhile microvascular disease is well described in systemic sclerosis (SSc), it is still unclear whether the occurrence of ischemic macrovascular events and atherosclerosis is enhanced among patients with SSc.MethodsIn this study, 111 SSc patients (74% of prevalent cases in Stockholm County) and 105 age- and sex-comparable population controls were investigated. Previous ischemic arterial events were tabulated. As surrogate measures of atherosclerosis, plaque occurrence and intima-media thickness (IMT) were determined with carotid ultrasound and the ankle-brachial index (ABI) was calculated. Traditional cardiovascular risk factors were recorded and we also measured biomarkers indicating systemic inflammation and endothelial activation/dysfunction.ResultsMean age was 62 ± 12 years for patients and controls. Ischemic arterial events were more common, due to increased occurrence of ischemic heart disease (IHD) and ischemic peripheral vascular disease (IPVD), in the patient group (12% vs. 4%, P = 0.03 and 9% vs. 0%, P = 0.003 respectively). On a group level, there was no difference regarding the occurrence of ischemic cerebrovascular disease, the frequency of plaques, IMT or ABI between SSc patients and controls. Subgroup analyses revealed that patients with anticentromere antibodies (ACA+) had more plaques and more ischemic arterial events compared to other SSc patients (67% vs. 39% and 32% vs. 11%; P = 0.006 and P = 0.01, respectively) and compared to controls (67% vs. 41% and 32% vs. 7%, P = 0.02 and P = 0.0003, respectively). Biomarkers of inflammation/endothelial activation were generally increased among SSc patients.ConclusionsPatients with SSc are at enhanced risk for IHD and IPVD. The ACA+ SSc subgroup was particularly affected with both ischemic arterial events and premature atherosclerosis. The microvascular vulnerability of ACA+ patients is previously well documented. We demonstrate that ACA+ SSc patients have an enhanced risk of macrovascular injury as well. This group should be followed closely and modifiable cardiovascular risk factors should be treated at an early stage.

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

“…Although increased CVD in SSc has been reported in population-based cohort studies (2)(3)(4)36), there are controversial data regarding the prevalence of atherosclerosis in SSc (9-11,13-18,37). The present study showed that SSc patients had significantly higher cIMT and more frequent carotid plaques and increased cIMT, i.e., subclinical atherosclerosis, compared to HS.…”

“…In multivariable analysis, only age, PAH, and elevated ESR were found to be independently associated with subclinical atherosclerosis in SSc. Regarding traditional CV (3,17,36,41). However, the effect of metabolic syndrome, a well-known CV risk factor, on atherosclerosis in SSc has not been evaluated yet.…”

“…Concerning disease characteristics, disease duration, anticentromere antibody positivity, cumulative glucocorticoid dose, and MRSS (negatively) have been reported to be associated with CVD and/or atherosclerosis in SSc (36,37,41,43). However, PAH was found to be associated with CVD only in a systematic review of the prevalence of coronary heart disease in SSc (1).…”

Central Hemodynamics and Arterial Stiffness in Systemic Sclerosis

“…49 Cabe destacar que la prevalencia de arteriopatía periférica isquémica y aterosclerosis prematura es más alta en los pacientes con ES y anticuerpos anticentrómero circulantes que en otros pacientes con ES, lo que confirma la vulnerabilidad microvascular de esta subpoblación de pacientes con ES. 50 Este estudio tiene limitaciones. El diseño transversal no permite demostrar la causalidad.…”

A qualitative systematic review of the prevalence of coronary artery disease in systemic sclerosis

“…Of the 13 studies, six had control groups matched for age and gender, 16,[18][19][20][21][22] two compared the SSc cohort with community-based cohorts drawn from the same geographical areas, 9,23 one study compared the results with the probability of CAD in the general population 24 and four did not have a control group. [25][26][27][28] Results are presented according to studies with (Table 3) or without a control group (Table 4).…”