Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: To investigate the occurrence of ischemic vascular events and subclinical atherosclerosis in patients with systemic sclerosis (SSc) and matched population controls.
Methods: 111 SSc patients (74% of the patients in Stockholm County) and 105 controls were investigated in this population-based study. Previous ischemic vascular events were defined as:
- Ischemic heart disease (IHD): myocardial infarction (confirmed by electrocardiography and a rise in plasma creatine kinase, muscle and brain fraction (CK-MB) or troponin T) or angina pectoris (confirmed by exercise stress test)
- Ischemic cerebral vascular disease (ICVD): cerebral infarction (confirmed by computer tomography) or transitory ischemic attacks (TIA, defined as transient focal symptoms from the brain or retina with a maximum duration of 24 hours),
- Ischemic peripheral vascular disease (IPVD): intermittent claudicatio + ankle-brachial index (ABI) < 0.9 or peripheral arterial thrombosis/embolus (confirmed by angiogram or Doppler flow studies).
As measures of subclinical atherosclerosis intima media thickness (IMT) and plaque occurrence was determined with carotid ultrasound and the ABI was calculated.
Results: Mean age was 62 ± 12 years for patients and controls. In the patient group disease duration was 9.4 (5.6 – 17.4) years, 78% had limited cutaneous systemic sclerosis (lsSSc) and 32% had anti-centromere antibodies (ACA). Ischemic vascular events were more common in the patients (18% vs 7%, p=0.01) due to an increased occurrence of both ischemic heart disease (IHD) and ischemic peripheral vascular disease (IPVD) (12% vs. 4% p=0.03 and 8% vs. 1% p=0.02 respectively). Ischemic cerebral vascular disease was uncommon in both the patient and control group. On a group level frequency of plaques, IMT or ABI did not differ between SSc patients and controls, but the subgroup of patients with ACA had more plaques in comparison both to other SSc patients (67% vs. 39%, p=0.006) and to controls (67% vs. 41%, p=0.02). Patients with ACA also had more ischemic events than other patients (32% vs 11% p=0.01) and controls (32% vs 7% p=0.0003)
|
|
Patients (n = 111) |
Controls (n = 105) |
Odd Ratio (95% CI) |
P-value |
|
Event % (n) |
18 (20) |
7 (7) |
3.1 (1.2 – 7.6) |
0.01 |
|
IHD % (n) |
12 (13) |
4 (4) |
3.3 (1.1–10.6) |
0.03 |
|
ICVD % (n) |
3 (4) |
3 (3) |
0.9 (0.2 – 4.7) |
ns |
|
IPVD % (n) |
8 (9) |
1 (1) |
9.2 (1.1 -73.7) |
0.02 |
|
Plaque % (n) |
48 (52) |
41 (43) |
1.3 (0.7 – 2.3) |
ns |
|
|
|
|
b-coefficient |
|
|
IMT mm |
0.68 ± 0.13 |
0.68 ± 0.13 |
-0.02 |
ns |
|
ABI |
1.13 (1.1–1.2) |
1.12 (1.1-1.2) |
-0.08 |
ns |
Conclusion: Patients with SSc have more ischemic heart disease and ischemic peripheral vascular disease than controls. The subgroup of SSc patients with ACA seems to be at particularly high risk to develop both ischemic event and premature atherosclerosis. This group should thus be followed closely and vascular prevention considered at an early stage when indicated. The importance to investigate subgroups of well-characterized patients is underscored by this study.
Disclosure:
A. Nordin,
None;
K. Jensen-Urstad,
None;
L. Björnådal,
None;
E. Svenungsson,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/vascular-ischemic-events-in-systemic-sclerosis-a-cross-sectional-comparision-with-population-based-controls/