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A5.1 Vitamin D and subclinical atherosclerosis in systemic sclerosis
  1. L Groseanu,
  2. R Jurcut,
  3. T Gudu,
  4. A Peltea,
  5. C Deaconu,
  6. A Balanescu,
  7. D Predeteanu,
  8. I Saulescu,
  9. D Opris,
  10. A Borangiu,
  11. R Ionescu
  1. Sf Maria Clinical Hospital, Department of Internal Medicine and Rheumatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Abstract

Background Whether scleroderma patients have an increased atherosclerotic risk or not is still a matter of dabate. Existing evidence suggests that impaired vitamin D metabolism, common in autoimmune diseases, might contribute to the development of atherosclerosis.

Objective To evaluate the relationship between vitamin D status and subclinical atherosclerosis in scleroderma patients.

Methods 20 scleroderma patients were evaluated. Radio frequency-based echo-tracking (Aloka alpha-10 Prosound, 15Mhz transducer) was performed to evaluate subclinical atherosclerosis. Several parameters were measured: intima-media-tchikness (IMT), βeta (stiffness parameter), Ep (pressure-strain elasticity modulus), AC (arterial compliance), AI (augmentation index), PWV (pulse wave velocity) in common carotid artery. 25(OH)D level was measured in the sera by an ELISA kit [DIASource® 25-Hydroxyvitamin D Total ELISA assay (Nivelles, Belgium)]. 25(OH)D levels were considered normal for values ≥30 ng/ml, insufficient for values between 20–30 ng/ml and deficient for values under 20 ng/ml.

Results The medium level of vitamin D was 20.71ng/ml, 37.5% of the patients being classified as insufficiency and 37.5% as deficiency. Patients with IMT ≥0.9mm had significantly lower levels of 25OH)D than those with normal IMT (13.78ng/ml vs. 25.67ng/ml, p = 0.034). Strong negative correlations were observed between vitamin D status and arterial rigidity parameters: β index (p < 0.001, r = -0.894), elastic modulus (p = 0.001, r = -0.760) and pulse wave velocity (p = 0.001, r = -0.728). Differences between groups were statistically significant when using ANOVA tests for beta index [F(2,13) = 13.069, p = 0.001] and elastic modulus [F(2,13) = 4.45, p = 0.034]. Post hoc Games Howell tests conformed the differences. βeta index was higher in patients with vitamin D insufficiency (7.10 ± 1.52, p = 0.004) or deficiency (11.3 ± 0.56, p = 0.05) compared to those with normal 25(OH) D levels (4.15 ± 0.07) and significantly higher in patients with deficiency compared with those with insufficiency (p < 0.001). Elastic modulus was higher in patients with insufficient (86.16 ± 27.48, p = 0.036) or deficient vitamin D levels (139.25 ± 54.09, p = 0.011) compared to those with normal status (53.25 ± 1.06) and higher in patients with deficiency compared with those with insufficiency (p = 0.04). Arterial compliance is higher in patients with normal vitamin D status than those with insufficient levels, in patients with insufficient levels compared with those with deficient levels but the difference are not significant (p = 0.77, p = 0.54).

Coincidence or not, the patient with the lowest 25 (OH)D in the group had significant carotid artery stenosis and developed stroke.

Conclusions We identified a strong negative correlation between 25(OH)D levels and arterial rigidity parameters, suggesting that low vitamin D status can be an additional risk factor factor for atherosclerosis in scleroderma patients.

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