Background/Purpose: Although numerous studies have reported different findings on subclinical and definite atherosclerosis (AS) in autoimmune rheumatic diseases, data in systemic sclerosis (SSc) are still challenging. The main objectives of our study were to assess surrogate biomarkers of subclinical AS as measured by carotid ultrasound and to evaluate potential relation with different cardiovascular risk factor in different settings of SSc.

Methods: We conducted a cross-sectional prospective study in 6 European EUSTAR (European Scleroderma Trials and Research) centers on 301 consecutive SSs patients enrolled in the SSAS (Early Accelerated Atherosclerosis in Systemic Sclerosis) cohort (88.3% women, 71.4% limited skin involvement SSc). Traditional (smoking, hypertension, diabetes, abnormal lipid pattern, familial history of cardiovascular disease) and non-traditional cardio-vascular risk factors (disease activity and severity, hsCRP, immune profile, glucocorticoids, synthetic immunosuppressives) as well as surrogate biomarkers for subclinical AS (carotid scanning measuring common carotid arteries intima-media thickness, cIMT, and plaques in common, internal and external carotid) were collected in all patients as a single point data. Subgroup analysis based on skin extent and serology profile was further performed using SPSS.  

Results: We reported an average of 0.65±0.14 mm  (0.43-1.20) for cIMT, with a slight tendency of higher values in diffuse cutaneous (dc) SSc subgroup as compared with limited cutaneous (lc) SSc with no statistically significance (p>0.05). In addition we identified several statistically significant correlations between cIMT and age, systolic blood pressure, abnormal lipid profile (cholesterol, total chol/HDL-col, triglycerides), disease duration, activity and severity (EUSTAR score, MEDSGER severity scale) (p<0.05), maintained in subgroup analysis. However, no significant relation with the glucocorticoid and immunosuppressive intake was demonstrated. At least one carotid plaque causing no or non-significant stenosis was observed in up to one third of cases, particularly in dcSSc, with age, smoking and hypertension independently associated with AS plaques, as well as the cumulative steroid dose (p<0.05). Although subgroup analysis suggested a higher values for AS parameters and risk factors in dcSSc as well as anti-SCL and ACA-positive patients, data were not statistically significant (p>0.05). Actual results confirm interim analysis data.

Conclusion: SSc is associated with an increased risk of developing subclinical AS, although early AS is not a hallmark of the disease. Age, dyslipidemia and hypertension as well as disease duration, activity and severity are listed as potential risk factors for AS particularly in dcSSc subtype.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-subclinical-atherosclerosis-in-patients-with-systemic-sclerosis-results-from-a-multicentric-cohort/