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Early atherosclerosis in systemic sclerosis and its relation to disease or traditional risk factors
Martha E Hettema1, Dan Zhang, Karina de Leeuw
1Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30,001, 9700 RB Groningen, The Netherlands. m.e.hettema@int.umcg.nl
Insights
Systemic sclerosis (SSc) patients did not show increased early atherosclerosis signs like intima-media thickness compared to healthy individuals. This study found no significant difference in carotid artery thickness or endothelial activation markers between groups.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Immunology
Background:
- Systemic autoimmune diseases, including systemic sclerosis (SSc), are linked to higher atherosclerosis rates beyond traditional risk factors.
- Microvascular issues are known in SSc, with prior research suggesting potential macrovascular involvement.
- This study investigated early atherosclerosis in SSc patients by comparing carotid artery intima-media thickness (IMT) to healthy controls.
Purpose of the Study:
- To compare the prevalence of early atherosclerosis in patients with systemic sclerosis (SSc) against healthy controls.
- To assess intima-media thickness (IMT) of the common carotid artery as a marker for early atherosclerosis.
- To evaluate the relationship between IMT, traditional cardiovascular risk factors, and markers of endothelial activation in SSc.
Main Methods:
- A cohort of 49 SSc patients (92% limited cutaneous SSc) and 32 healthy controls underwent B-mode ultrasound for common carotid IMT measurement.
- Traditional cardiovascular disease risk factors were assessed in all participants.
- Serum markers of endothelial activation were measured to evaluate vascular health.
Main Results:
- Mean IMT was not significantly different between SSc patients (0.69 mm) and healthy controls (0.68 mm) (P = 0.067).
- Adjusted analyses for confounders (age, HDL, LDL cholesterol, history of macrovascular disease) also revealed no significant IMT difference.
- Atherosclerotic plaques were found in three SSc patients but none in controls (P = 0.274), and no correlations were observed between IMT, disease variables, or endothelial markers in SSc patients.
Conclusions:
- Systemic sclerosis (SSc) is not associated with an increased prevalence of early signs of atherosclerosis.
- Common carotid intima-media thickness does not appear to be significantly elevated in SSc patients compared to controls.
- Endothelial activation markers were not found to be increased in SSc patients, suggesting no heightened systemic endothelial dysfunction contributing to atherosclerosis in this cohort.
Introduction:
Several systemic autoimmune diseases are associated with an increased prevalence of atherosclerosis which could not be explained by traditional risk factors alone. In systemic sclerosis (SSc), microvascular abnormalities are well recognized. Previous studies have suggested an increased prevalence of macrovascular disease as well. We compared patients with SSc to healthy controls for signs of early atherosclerosis by measuring intima-media thickness (IMT) of the common carotid artery in relation to traditional risk factors and markers of endothelial activation.
Methods:
Forty-nine patients with SSc, of whom 92% had limited cutaneous SSc, and 32 healthy controls were studied. Common carotid IMT was measured by using B-mode ultrasound. Traditional risk factors for cardiovascular disease were assessed and serum markers for endothelial activation were measured.
Results:
In patients with SSc, the mean IMT (median 0.69 mm, interquartile range [IQR] 0.62 to 0.79 mm) was not significantly increased compared with healthy controls (0.68 mm, IQR 0.56 to 0.75 mm; P = 0.067). Also, after correction for the confounders age, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein cholesterol (P = 0.328) or using a different model taking into account the confounders age, HDL cholesterol, and history of macrovascular disease (P = 0.474), no difference in IMT was present between SSc patients and healthy controls. Plaques were found in three patients and not in healthy controls (P = 0.274). In patients, no correlations were found between maximum IMT, disease-related variables, and markers of endothelial activation. Endothelial activation markers were not increased in SSc patients compared with controls.
Conclusion:
SSc is not associated with an increased prevalence of early signs of atherosclerosis.
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