Background Increased cardiovascular (CV) risk and atherosclerosis have been described in patients with rheumatic diseases including systemic sclerosis (SSc). Besides traditional CV risk factors, endothelial dysfunction, and disease-specific factors, such as the underlying inflammatory process and medications have been suggested as possible etiologic factors for atherosclerosis in SSc. Increased Carotid Intima-media thickness (IMT), associated with CV risk in general population, has been found to be increased in SSc patients. In RA and other inflammatory arthritis, EULAR recommends annual CV risk assessment according to national guidelines, but there are no recommendations to evaluate CV risk in SSc patients.
Objectives To asses CV risk in SSc patients using the SCORE chart calibrated for Spain (SCOREm) and to determine the percentage of patients reclassified according to the presence of plaques by the use of common carotid artery (CCA) ultrasonography (US). To analyse the factors that predict a higher global CV risk.
Methods All patients with SSc, fulfilling the 1980 ACR SSc criteria or the proposed 2001 criteria for early SSc were prospectively included in a database created in 1989 at the “Hospital Doce de Octubre”, containing demographic and clinical information. For the study, 200 living spanish patients were selected. Classic CV risk factors, previous ischemic events, acute phase reactants (APR) and lipid profile were obtained. CV risk was calculated using the SCOREm. We evaluated the presence of plaques and measured the CCA IMT by B doppler US in 140 consecutive patients. Chi-square or McNemar’s tests were used to assess differences between qualitative variables, and ANOVA with Bonferroni adjustment for comparing means. Factors predicting higher global CV risk were evaluated by multivariate lineal regression analysis.
Results Most patients (89%) were women, 65% had limited cutaneous involvement. Mean age was 55±16 years and mean disease duration was 14±10 years. Mean SCOREm was 1,5±1,7. Low CV risk was found in 116 (58%) patients, intermediate, high and very high risk in 73 (36,5%), 10 (5%) and 1 (0,5%) respectively. After CCA US was performed, plaques were found in 31/140 (22%) patients. Of these, reclassification to high risk was done in 11 and 19 patients with low and intermediate risk (p<0,001). Mean IMT was 0,63±0,12 mm. Higher global CV risk was predicted by lung involvement, higher values of IMT, diabetes and dyslipemia.
Conclusions In our study most SSc patients have low and intermediate CV risk using the SCOREm chart, but after performing CCA US 30 (21,4%) patients were reclassified into high risk by the presence of plaques. Higher global CV risk was predicted by lung involvement, higher values of IMT, diabetes and dyslipemia. Our preliminary data suggest that not only classic CV risk factors, but also the underlying inflammatory processes might contribute to the expression of the subclinical atherosclerosis measured by ultrasound.
MJL Peters et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010; 69: 325-31.
Disclosure of Interest None Declared
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