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Abstract Number: 702

Arterial Stiffness Is Increased in Systemic Sclerosis: A Cross-Sectional Comparison with Matched Controls

Gene-Siew Ngian1, Joanne Sahhar2, Ian Wicks3 and Sharon Van Doornum4, 1Department of Medicine (RMH/WH), The University of Melbourne, Parkville, Australia, 2Rheumatology Unit, Monash Medical Centre, Clayton, Australia, 3Rheumatology Unit, Royal Melbourne Hospital, Melbourne, Australia, 4Department of Medicine (RMH/WH), The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease and systemic sclerosis

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Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s – Clinical Aspects and Therapeutics

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Atherosclerosis may be increased in systemic sclerosis (SSc)1. Increased arterial stiffness is a predictor of cardiovascular and all-cause mortality across a wide range of patient populations. Our aim was to determine if arterial stiffness is elevated in SSc and to evaluate correlates of arterial stiffness in SSc patients.

Methods:

We performed two studies: 1) a comparison of arterial stiffness in 40 SSc patients free from cardiovascular disease or significant vascular manifestations of SSc (i.e. pulmonary arterial hypertension or scleroderma renal crisis) and 40 age- and sex-matched healthy controls, and 2) an analysis of determinants of arterial stiffness in a larger, unselected cohort of 80 SSc patients (which included the 40 patients from study 1). Arterial stiffness was measured using the augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV), both of which increase with increasing arterial stiffness.

Results:

In study 1 the SSc and control groups were well matched for age (52.2 vs 50 years respectively), sex (80% female in both groups) and cardiovascular risk factors. SSc patients had significantly higher AIx than controls (31.2+8.4 vs 20.9+12.6% respectively, p<0.001), with a non-significant increase in PWV (7.3+1.8 vs 6.8+1.1m/s respectively, p=0.101).

In study 2, univariate analysis of the entire SSc cohort revealed that higher AIx was significantly associated with age (p<0.001), disease duration (p=0.001), anti-centromere antibody positivity (p=0.016), calcium channel blocker (CCB) therapy (p=0.004), systolic blood pressure (BP) (p=0.001) and diastolic BP (p=0.029). Higher PWV was significantly associated with age (p<0.001), disease duration (p=0.001), anti-centromere antibody positivity (p=0.022), lack of anti-Scl-70 antibody positivity (p=0.001), lower modified Rodnan skin score (p=0.016), angiotensin converting enzyme inhibitor therapy (p=0.035), systolic BP (p<0.001) and diastolic BP (p<0.001). After adjusting for age, CCB therapy remained predictive of higher AIx (p=0.014) and systolic (p<0.001) and diastolic (p=0.005) BP remained predictive of higher PWV.

Conclusion:

Compared with healthy controls, SSc patients had increased arterial stiffness, with significantly higher AIx and non-significantly higher PWV. This suggests that patients with SSc may have an increased prevalence of subclinical atherosclerosis. After adjusting for age, CCB therapy was associated with higher AIx, which is paradoxical given that CCB therapy in hypertensive individuals decreases arterial stiffness, if anything2. Given that CCBs are first-line therapy for Raynaud’s phenomenon in SSc, this association could reflect generalized vasculopathy rather than atherosclerotic disease. Prospective studies in large cohorts of patients are warranted to clarify this point and elucidate other determinants of arterial stiffness in SSc.

1. Prevalence of coronary heart disease and cardiovascular risk factors in a national cross-sectional cohort study of systemic sclerosis. Ann Rheum Dis 2012; doi:10.1136/annrheumdis-2011-201176.

2. Effects of Antihypertensive Drugs on Arterial Stiffness. Cardiol Rev 2012; doi: 10.1097/CRD.0b013e31825d0a44.


Disclosure:

G. S. Ngian,
None;

J. Sahhar,
None;

I. Wicks,
None;

S. Van Doornum,
None.

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