Background/Purpose: During the last decade, it has been shown that cardiovascular disease (CVD) in systemic sclerosis (SSc) is increased and accounts for ~30% of the SSc mortality. However, whether this is due to accelerated atherosclerosis and how to detect patients with high risk are still unclear. In this study we aimed to determine the frequency of subclinical atherosclerosis in patients with SSc compared to rheumatoid arthritis (RA) and to determine the ability of CV risk indices in detecting those SSc patients with high CV risk.

Methods: Eighty one SSc patients (F/M=74/7; mean age 49.7±12.1 years)  and 80 age- and sex-matched RA patients (F/M=73/7; mean age 50.1±10.5 years) without a history of CVD were assessed. All patients were evaluated with carotid ultrasonography (US). Carotid intima-media thickness (cIMT) > 0.90 mm and/or carotid plaques were used as the gold standard test for subclinical atherosclerosis and high CV risk (US+). Systematic Coronary Risk Evaluation (SCORE), QRisk II and 2013 American College of Cardiology/American Heart Association (ACC/AHA) 10-year atherosclerotic CV disease risk (ASCVD) indices were calculated.

Results: Fifteen patients (18.5%) in SSc group and 19 patients (23.8%) in RA group were US+ and the presence of subclinical atherosclerosis and the mean cIMT were similar in SSc and RA patients (P=0.41, P=0.74, respectively) (Table 1). None of the CV risk factors in SSc patients were worse than RA patients except for lower HDL-chol levels (Table 1). However atherogenic index (Total-chol/HDL-chol) were not different (3.6±0.9 vs 3.5±1.1, P=0.67). When US+  and US- SSc patients were compared, it was observed that US+ SSc patients were older, had significantly more pulmonary arterial hypertension (PAH), elevated ESR, HT and less immunsuppressive usage than US- patients.  In multivariable logistic regression analysis, age (OR=1.1, 95% CI [1.02-1.8], P=0.014), elevated ESR (OR=9.3, 95% CI [1.6-55.5], P=0.014) and PAH (OR=4.8, 95% CI [1.12-20.8], P=0.035) were independently associated with subclinical atherosclerosis. Concerning CVD risk indices, all 3 CV risk indices for general population failed to identify patients with subclinical atherosclerosis. Of the 15 US+ patients only 0 (0%), 1 (6.7%) and 3 (20%) patients were classified as high CV risk according to SCORE, QRisk II and ACC/AHA 10-year ASCVD risk, respectively.  

Conclusion: Subclinical atherosclerosis in SSc is as frequent as in RA in which accelarated atherosclerosis is clearly defined. Atherosclerosis in SSc is independently associated with age, elevated ESR and PAH. However CV risk indices for general population, SCORE, QRisk II and ACC/AHA 10-year ASCVD risk are considerably insufficient to detect those patients with subclinical atherosclerosis. In future studies, elevated ESR and presence of PAH may be helpful in the SSc-specific CV risk estimation.  

Table 1. CV risk factors of SSc and RA patients  

The values were presented as mean±SD

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-atherosclerosis-and-estimation-of-cardiovascular-risk-in-systemic-sclerosis/