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SAT0233 Descriptive Study of Cardiovascular Risk Factors and Endothelial Disfunction in Patients Diagnosed with Scleroderma and Mixed Conective Tissue Disease
  1. J.J. Gonzalez Martin1,
  2. O. Carrion2,
  3. A. Abdelkader2,
  4. E. Calvo1,
  5. M. Valero1,
  6. S. Rodriguez1,
  7. I. Amil1,
  8. C. Marin1,
  9. C. Sangüesa1,
  10. L. Ruiz1,
  11. F. Aramburu1,
  12. F. Sainz2,
  13. P. Garcia de la Peña1
  1. 1Rheumatology
  2. 2Vascular Surgery, Hospital Madrid Norte Sanchinarro, Madrid, Spain

Abstract

Background Cardiovascular complications are a common cause of morbidity in inflammatory arthritis and connective tissue diseases like several studies have shown.

Objectives Detection of cardiovascular risk factors and endothelial dysfunction in patients diagnosed with Systemic Sclerosis (SSc) and Mixed Connective Tissue Disease (MCTD). Creation of a longitudinal cohort of patients.

Methods Studies have been collected from April 2012 to December 2015. The data collection protocol included BMI, dyslipidemias, DM, HTN, previous or active smoking, thrombotic episodes, strokes and ischemic cardiopathy. ESR, CPR, cholesterol level, LDL, HDL, triglycerides, 25OH-D and homocysteine levels were requested to all patients. Vascular surgery's ultrasound protocol was: 1. Carotid study, intima-media thickness (IMT) and presence of plaques; 2. Ankel branquialindex (ABI), being pathological when ABI ≤0.9; 3. Endothelial dysfunction was assessed measuring abnormal brachial artery flow-mediated dilatation (FMD) after a four minutes transient ischemia period, being patologic if FMV <10% and severe if <5%.

Results A total of 61 patients (95.1% women) were included: 28 SSc limited, 21 SSc diffuse, 2 SSc Sine Scleroderma, 4 MCTD, 3 overlap SSc-polymyositis and 3 Prescleroderma. The mean age at the time of the study and diagnosis were 49 (19–76) and 46 years (17–75). The average time of the disease was 5 years (0–37). 7 patients had HTN, 2 had DM, 18 hyperlipidemia (10 HCL, 2 HTG, 6 mixed hyperlipidemia), 9 active smokers, 18 ex-smokers, 2 patients with stroke, 2 have had thrombotic episodes and 1 had ischemic heart disease. The mean BMI was 24 (18–50) and 37.3% had a BMI>25.

The mean value of the different analytic parameters was: ESR: 15 mm/h (1–55), PCR: 2.7 mg/L (0,1–22), COL: 198 mg/dL (143–298), 25OH D Vitamin:23,6 ng/mL (12–118), homocystein 10.8 micromol/l (5,9–19,5) and 21.4% had pathological levels ≥15 micromol/l. The mean modified Rodnan skin score was 9 (0–42), 20% of patients had ILD and 3 patients had PAH. 64% patients were treated with steroids, 65% DMARDs and 13.1% biologic therapies.

The echographic findings were the following:

1. The mean right and left common carotid IMT were 0.6 (0.47–1.2) and 0.7 mm (0.44–1.3) respectively. 66% and 61.2% of the cases had an increase of right and the left IMT respectively and 43% of both when it was compared with age group of reference population.

2. 26% had unilateral plaques and 7% bilateral plaques.

3. Three patients had a pathologic ABI.

4. The average FMV was 4%, 80% cases had endothelial dysfunction, being severe in 51% of these.

Conclusions 1. Nearly 40% of patients have overweight (BMI>25).

2. A high percentage of patients (16%) have hyperhomocyisteinemia.

3. The percentage of subjects with increased IMT is high, around 65%. The presence of plaques is less frequent (30%).

4. Endothelial dysfunction was found in 80% of the cases, and it was severe in almost 50%.

  1. Man A et al. The risk of cardiovascular disease in systemic sclerosis. Ann Rheum Dis. 2013 Jul;72(7):1188- 93.

  2. Tyndall AJ et al. Causes and risk factors for death in systemic sclerosis: a study from the EUSTAR database. Ann Rheum Dis. 2010 Oct;69(10):1809–15.

Disclosure of Interest None declared

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