Background/Purpose: Patients with systemic sclerosis (SSc) may be burdened by increased cardiovascular (CV) risk due to accelerated atherosclerosis (ATS) due to systemic inflammation, and vascular impairment. This study aimed to evaluate CV risk in SSc patients SSc compared to healthy controls (HC) and to assess its association with disease-specific features.

Methods: 92 patients with SSc (81 females; mean age 52; mean disease duration 6.8 years; diffuse cutaneous (dc)SSc: n=28, limited cutaneous (lc)SSc: n=64) and 197 HC (147 females, mean age 56.7) were included, all with no history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events). Comorbidities and current treatment were recorded. Disease activity and organ involvement were evaluated in SSc, including lung function tests and skin involvement (by mRSS). All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (by densitometry (DXA) and bioelectrical impedance analysis (BIA)). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE, charts for the European population) and its modifications: SCORE multiplied by the coefficient 1.5 (mSCORE), and SCORE2.

Results: SSc patients had a trend to higher prevalence of dyslipidemia (p=0.063) and significantly more often prediabetes (p< 0.001) than HC, but a comparable prevalence of arterial hypertension, diabetes mellitus, and current smoking to HC. Nevertheless, SSc had significantly more frequent use of antihypertensive treatment compared to HC (p< 0.001), including calcium channel blockers (indicated for Raynaud’s phenomenon).

The prevalence of carotid artery disease was significantly increased in SSc compared to HC. SSc had significantly more unfavorable CIMT and ABI (p< 0.05 for both). There was only a trend to lower SCORE and overall CV risk based on SCORE in SSc compared to HC, but no significant difference in SCORE2. On the contrary, the overall CV risk based on US examination showed significantly higher CV risk in SSc. A comparison of CV risk with the findings of subclinical ATS on US examination showed that none of the CV risk scoring systems in SSc was exact in estimating the CV risk (Figure 1). Nevertheless, SCORE2 underestimated the real CV risk significantly less than SCORE (p=0.043), while SCORE2 vs. mSCORE and SCORE vs. mSCORE were comparable. In SSc, the CV risk and markers of subclinical ATS were associated especially with age, HbA1c, disease duration, and mean arterial pressure (p< 0.05 for all).

Conclusion: This cross-sectional case-control study in SSc patients demonstrated a significantly increased risk of subclinical ATS in SSc compared to HC, although there was an opposite trend in CV risk estimated by calculated SCORE. The CV risk in SSc was associated especially with age, disease duration, and HbA1c levels, among others. Scoring systems underestimated the CV risk (when compared to ultrasound findings), while SCORE2 was significantly more accurate than SCORE.

Supported by MHCR (023728; NV18-01-00161A; NU21-01-00146).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-cardiovascular-risk-in-patients-with-systemic-sclerosis-and-the-general-population/