Background In Systemic sclerosis (SSc), as in other autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus, cardiovascular events are one of the most frequent causes of mortality not attributed to the disease itself.
Objectives The aim of this study was to assess the presence of subclinical atherosclerosis by carotid Doppler ultrasound in SSc patients under 55 years.
Methods We conducted a cross-sectional study that included 78 SSc patients without cardiovascular events from H. Vall d'Hebron cohort (Barcelona). Carotid Doppler ultrasound was performed to measure the Carotid Intima Media Thickness (CIMT) of common carotid artery (CCA) and detection of cholesterol plaques in CCA, bulb and internal and external carotid arteries, according to Mannheim consensus criteria. The results were compared to a healthy cohort from Barcelona, adjusted to age and sex1. We used SCORE for populations with low risk and REGICOR as cardiovascular risk assessment charts.
Results Risk factors and SSc related features are described in table 1. Twenty three patients (29.5%) had carotid plaques (CP) being the presence of CP statistically significant compared to the healthy cohort (29.5% vs 15.6%; p<0.05; IC 0.04–0.24). None of the patients were catalogued as high risk according to SCORE chart. According to REGICOR chart, 4 patients (5.1%) were catalogued as intermediate risk and none as high risk. The four intermediate risk patients had CP. Carotid Intima Media Thickness mean (CIMTm) and maximum (CIMTmax), were statistically significant increased compared to the healthy cohort (CIMTm 0,57 vs 0,53; p<0,05 and CIMTmax 0,74 vs 0,61; p<0,05).
We performed multivariate regression analysis. Age, CIMTmax, low High Density Lipid (HDL), the presence of pulmonary hypertension, and Diffuse cutaneous SSc patients were independent factors for the presence of CP.
Conclusions SSc patients under 55 years old often have subclinical atheromatous disease which could be detected by carotid ultrasound. Risk charts do not correlate with the presence of subclinical atheromatous disease. The presence of carotid plaque is more frequent in SSc patients with pulmonary hypertension, diffuse cutaneous subtype and patients with low HDL. CIMT could be useful although it is currently not recommended in cardiovascular risk guidelines.
Junyent M, Gilabert R, Núñez I, Corbella E, Vela M, Zambόn D, et al. Carotid ultrasound in the assessment of preclinical atherosclerosis. Distribution of intima-media thickness values and plaque frequency in a Spanish community cohort. Med Clin (Barc). 2005;125(20):770–4.
Disclosure of Interest None declared