Subclinical atherosclerosis in systemic sclerosis: Different risk profiles among patients according to clinical manifestations

Introduction: Like other autoimmune diseases, systemic sclerosis (SSc) has been described to be associated with accelerated atherosclerosis (ATS). Before clinical manifestations of cardiovascular disease (CVD) occur, subclinical ATS can be investigated in different ways. Aim: To evaluate the presence of subclinical ATS in a group of patients with SSc, and to identify different risk profiles among patients. Methods: Subclinical ATS was reviewed in 43 SSc patients and 27 healthy controls, using 2 methods: carotid ultrasound and flow mediated dilation (FMD) of the brachial artery. Results: Plaques were statistically more frequent in SSc patients than in controls (65% vs 30%, P =.006); intima-media thickness of common carotid artery (CCA-IMT) resulted in statistically higher (median value 0.8 mm vs 0.55 mm; P <.0001) while FMD was significantly lower (median value 9% vs 14%; P =.0086) in patients compared to healthy controls. Among the SSc patients, thickening of CCA-IMT was significantly associated with the presence of diastolic dysfunction of left ventricle (absence of diastolic dysfunction: odds ratio [OR] 0.2, 95% CI 0.04-0.92, P =.038) and with a higher Framingham score (OR 1.3, 95% CI 1.03-1.6], P =.024). The diffuse cutaneous form was slightly protective against pathological FMD (OR 0.12, 95% CI 0.022-0.71, P =.019). Conclusions: This study confirms the involvement of macrocirculation in SSc patients, detecting the presence of subclinical ATS markers more frequently in patients compared to healthy controls. Framingham score, diastolic dysfunction of left ventricle and limited cutaneous form of the disease appeared to be associated with a higher risk of developing ATS.