Background Recently published population-based cohort studies had shown a high prevalence of cardiovascular (CV) disease in Systemic Sclerosis (SSc) patients.
Objectives The aim of this study is to compare three different methods to measure CV risk in patients with scleroderma.
Methods We conducted a cross-sectional study in a single center that included 43 SSc patients without CV events. We used both CV risk assessment charts SCORE for populations with low CV risk and REGICOR algorithm adjusted to Spanish subjects. Coronary Compute Tomography (CT) with coronary arterial calcium score (CACscore) was performed considering several cut-off points as predictors of CV risk. Carotid doppler ultrasound was performed to measure the Carotid Intima Media Thickness (CIMT) and for the detection of cholesterol plaques, according to Mannheim consensus criteria.
Results Risk factors and SSc related features are described in table 1. None of the patients were catalogued as high risk according to SCORE chart (>5%). According to REGICOR chart, 17 patients (39,5%) were catalogued as intermediate risk and none as high risk. Twenty-two patients (51,2%) had carotid plaques (CP) and the CACscore of these patients was 283.4. In patients without CP CACscore was 53,2 (p<0.05).
Based on the presence of CP we performed ROC curve with CACscore. The AUC was 0.778. The best cut off point was 28 with a sensibility of 71% and a specifity of 82%. Kappa's coefficient was 0.54. Twenty patients (46.5%) had CACscore>28. Compared to patients with CACscore<28 statistical significance was found on CIMTmax (0.93 vs 0.80mm; p<0.01), presence of CP (79% vs 25%, p<0.01) and number of CP (2.55 vs 0.43, p<0.01). There was no statistical significance on CIMTm (0.71 vs 0.64mm p: 0.11).
If the presence of CP or CAC score>28 were considered as subclinical atheromatosis disease (SAD), a total of 26 patients (60.5%) were diagnosed. We performed multivariate regression analysis, CIMTm, CIMTmax, low High Density Lipid (HDL), high erythrocyte sedimentation rate (ESR) and age were independent factors for the presence of SAD.
Conclusions SSc patients often have SAD which is misdiagnosed by CV risk charts. Plaque detection by carotid ultrasonography and CT CACscore are useful to detect SAD. The optimal cut-off point of CACscore in this study is 28. SAD detection would be indicated in elderly, patients with low HDL or high ESR. The measure of CIMT could be useful in some cases.
Disclosure of Interest None declared
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