Background Cardiac involvement is one of the important factors of a poor prognosis in Systemic Sclerosis (SSc). Different pathogenetic mechanisms are involved in heart pathology in SSc, including microvascular disease and the atherosclerotic process. The relationship between primary cardiac involvement and atherosclerosis (AS) is under investigation.
Objectives To evaluate frequency of the traditional cardiovascular disease risk factors (TRF) and their relations with the heart structure abnormalities in SSc
Methods 125 pts with SSc (113 women, mean age 51±12 years, mean duration of the disease 8, 9±8) who met to ACR/EULAR criteria (2013). The limited type of the disease had 73% of pts. There were no cases of nephropathy, 18 pts (15%) had systolic pulmonary arterial pressure (PAP) >40 mmHg and 63 (50%) had interstitial lung disease. The assessed TRF were age, sex, overweight (a body mass index [BMI] >25 kg/m2, arterial hypertension [AH] (>140/90 mmHg), DM, smoking, total cholesterol (TC). The ten-year risk of fatal cardiovascular disease (CVD) was evaluated by SCORE. 50 age- and sex matched volunteers were used as a control. Echocardiography (ECHO) was performed in 121 pts
Results The increased BMI was detected in 60 (48%) of pts and 15 (30%) of controls (p=0, 03). The TC level was >5, 2 mmol/l in 69 (55%) of pts and 38 (76%) of controls (p=0, 01). Arterial blood pressure (ABP) was elevated in 33 (25%) of pts and in 16 (32%) of controls (p>0, 05), the frequency of others TRF was not significantly different from controls. The high/very high SCORE >5% had 36 (28, 8%) of pts and 4 (8%) of controls (p=0,003). Among them the very high risk (SCORE >10% or coronary heart disease and experienced a cardiovascular event) had 20% of pts and 6% of controls (p=0, 02). The low/moderate values of SCORE <5% had 89 (71%) of pts and 46 (92%) of controls (p=0,003). When compared pts >50 and ≤50 yrs. the higher prevalence of AH (36% and 12%, p=0,003) and hypercholesterolemia (62, 7% and 44%, p=0, 04) were demonstrated in older pts. The ECHO revealed abnormalities in 100 (83%) of pts. The prevalence of ECHO changes was significantly higher in pts with AH when compared to pts with normal level of ABP. The following changes had higher rate in pts with AH: the diastolic dysfunction of left ventricle (LV) (60,6% and 36,4%, p=0,016), thickened aortic (88% and 52%, p=0,0003) and/or mitral leaflets (69,7% and 36%, p=0,001); calcinosis of aortic (36% and 16%, p=0,015) and/or mitral leaflets (33% and 4,5%, p=0,000), dilatation of the left atrium (30% and 8%,p=0,0016). The rate of ECHO valvular abnormalities was higher in pts who were older 50 yrs compared with those <50 yrs. The LV hypertrophy was revealed in 10/58 of pts with overweight and in 3/63 of pts with normal weigh (p=0, 03). The prevalence of thicked aortic leaflets was higher in pts with elevated level of TC comparing with those who had normal values of TC in sera (p=0, 02).
Conclusions Our study displayed the higher cumulative 10-year risk for CVD according to SCORE and indicated a higher prevalence of clinical AS (CHD) ischemic arterial events) in SSc comparing with controls. Presence of the TRF in patients was assosiated with more severe heart structure abnormalities. Appropriate management should be carried for high CVD risk categories of patients, especially in older ones in presence of systemic AH.
Disclosure of Interest None declared