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AB0606 Factors Related with The Development of Atherosclerosis in Patients with Systemic Sclerosis
  1. J.J. Alegre Sancho1,
  2. M. Robustillo Villarino1,
  3. C. Vergara Dangond1,
  4. G. Albert Espi1,
  5. D. Ybáñez García1,
  6. E. Valls Pascual1,
  7. À. Martínez-Ferrer1,
  8. E. Vicens Bernabeu1,
  9. M. Aguilar Zamora1,
  10. J.A. Román Ivorra2
  1. 1Rheumatology, Hospital Universitario Dr. Peset
  2. 2Rheumatology, Hospital Universitari i Politècnic la Fe, Valencia, Spain

Abstract

Background Different studies and meta-analysis have shown that subclinical atherosclerosis (AS) and vascular complications (VC) are higher in patients with Systemic Sclerosis (SSc) than in healthy population, a fact that has been fundamentally related to non traditional vascular risk factors (VRF).

Objectives To identify VRF which shows to be independently related to the existence of macrovascular affection (carotid ultrasound, ankle-braquial index [ABI]) in patients with SSc.

Methods Transverse descriptive study with analytical components. Study population: cohort of 115 patients with SSc controlled in the Rheumatology Department of a tertiary hospital. Variables: 1) Clinical variables; 2) Questionnaires and indices: global VAS, HAQ, SF-36, CHFS (Cochin Hand Function Scale),MHISS (Mouth Handicap In Systemic Sclerosis scale), HOMA and SCORE; 3) Analytical variables: hemogram, classic vascular risk biomarkers, activity/inflammation biological markers, autoantibody profile, hemostasis/vascular disease markers; 4) Vascular study: ABI and carotid doppler ultrasound (ESAOTE MyLab XV70, 7–12 MHz linear transducer, software RFQIMT) measuring intima-media thickness (IMT) and the presence of atheroma plaques (Mannheim Consensus); 5) Other variables: acro-osteolysis, ECG, functional pulmonary tests, lung HRCT and doppler echocardiography. A vascular surgeon measured ABI and the carotid doppler ultrasound was done by a vastly experienced rheumatologist, blind to the rest of findings, in a term of 3 months after the initial evaluation. Statistical analysis: IBM-SPSS Statistics v22.0 package.

Results 115 patients where included, of which 108 were studied; with a mean age of 60,16 years (SD ±15,16); 99 women (91.7%) and 9 men (8.3%.) Mean SSc evolution time was 11.45 years (SD ±8,84). LSSc was most frequently diagnosed (50%), followed by SSc without scleroderma (18.5%), DSSc (16.7%), overlap syndrome (9.3%) and pre-SSc (5.6%). 38.9% of patients were hypertensive, 46.3% suffered a DL, and 6.3% were diabetic. 37% had a pathological carotid ultrasound and 39.8% had macrovascular damage (atheroma plaque and/or IMT>0.9 mm and/or ITB<0.9). The bivariate analysis showed a relation between macrovascular disease and several traditional and non traditional (related to the disease) VRF. In the multivariate analysis, age, HTA, DL, systolic pressure, glycaemia, renal function,VC history, SCORE values, SF36, duration of the SSc, coexistence of an inflammatory disease, diastolic dysfunction of the LV, ESR, D-dimer values, estimated PsAP values, and the use of different drugs (statins, ACEI, ARBs, endothelin receptor antagonists, rituximab) maintained a significant relationship with the different macrovascular disease variables.

Conclusions Macrovascular disease in patients with SSc associates with traditional VRF (age, HTA and DL) as well as VRF related to SSc (prolonged duration, greater inflammatory load, elevated PsAP values, diastolic dysfunction of LV). A strict control of blood pressure values and the use of statins should be part of the regular protocol for treating selected, elderly patients.

Disclosure of Interest None declared

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