Background Atherosclerosis is a common cause of mortality and morbidity in many autoimmune diseases. There is not much evidence about the role of atherosclerosis in increase mortality in systemic scleroderma.
Objectives The aim of study is detection of subclinical atherosclerosis measured by ultrasound detected intima media thickness in a group of systemic scleroderma patients and finding relation to traditional risk factors, clinical manifestation, immunological profile and selected laboratory markers.
Methods From March 2015 to January 2016 55 patients with systemic scleroderma were included in the study. (9 men. 46 women, mean age - 59±10.5y., age of diagnosis 51.2±12.3y., duration of disease 5±8.5y., duration of Raynaud's phenomenon 8±12.1y.). In these patients data were collected on traditional atherosclerosis risk factors (smoking, BMI, arterial hypertension, Diabetes, lipid profile, family history of cardiovascular event), on the phenotype of scleroderma disease (lung manifestation, pulmonary hypertension, digital ulceration, involvement of gastrointestinal tract, myositis, renal crisis). The immunological profile of the disease was assessed by analysis of autoantibodies. All patients were tested by complex psychological test - MMPI-II (The Minnesota Multiphasic Personality Inventory test, standardized psychometric test of adult personality and psychopathology) and BDI-II test (Beck Depression Inventory test of depression). The presence of subclinical atherosclerosis was assessed by ultrasound measurement of intima media thickness (IMT) and by assessment of presence carotic plaque. Echocardiography aimed for detection of pulmonary hypertension, left ventrical function and valvlular disease was done. Statistical tests (descriptive statistic, Student t-test, Spearman test and ANOVA) were performed to describe eventual relation of findings, p-value ≤0.05 considered as significant.
Results Pathological IMT was detected in 31 (56.3%), plaques in 19 patients (34.5%). In this group was low incidence of cardiovascular events – 1 ischemic heart disease, 1 myocardial infarction and one stroke, prevalence presence of valvuvar disease (16 patients, 29.1%). IMT correlated with disease duration (p=0.01), positivity of anti Scl 70 (p=0.02), TC/HDL ratio (p=0.02), hsCRP (p=0.05), presence of PH (p=0.002), digital ulceration (p=0.007), gastrointestinal damage (p=0.04), but also with MMPI-II scale of depression (p=0.03) and hypochondria (p=0.01) and BDI-II summary score (p=0.04). Presence of plaques correlated with disease duration (p=0.05), diffuse form (p=0.01), TC and HDL ratio (p=0.02), hsCRP (p=0.02), digital ulceration (p=0.03) and MMPI-II measured scale of conversion hysteria (p=0.01) and BDI-II summary score (p=0.03).
Conclusions Patients with scleroderma in our study had low presence of cardiovascular manifestation. Nevertheless prevalence of latent atherosclerosis detected by increase IMT and presence of atherosclerotic plaques of carotic artery is high and correlates with some organ manifestations (pulmonary hypertension, digital ulceration). Presence of atherosclerosis correlates also with subclinical depression assessed by complex psychological tests.
Acknowledgement Grant support: MZ CR VES15–28659A
Disclosure of Interest None declared