Macrovascular involvement in systemic sclerosis: evidence of correlation with disease activity

Systemic sclerosis (SSc) is considered as a systemic disease which mainly affects small vessels. However, macrovascular involvement in SSc is still elusive in literature. Our study is to evaluate the macrovascular involvement in SSc patient and its association with atherosclerosis, disease activity and other factors.

Forty-eight SSc patients were studied; 46 healthy people were enrolled as control subjects. Data on traditional cardiovascular risk factors, disease duration, inflammation indices, antibodies and other vascular involvement were collected. Systolic/diastolic interarm difference (sIAD/dIAD), pulse wave velocity (PWV) and ankle brachial index (ABI) were determined using a pulse pressure analyser. Peripheral arterial disease (PAD) was defined as ABI <0.90.

A lower ABI (0.91±0.19 versus 1.09±0.08; p<0.001) and a higher sIAD (5.0 [range 0~35] mmHg versus 2.0[0~15] mmHg, p<0.001) were found in patients with SSc. ABI is negatively correlated with sIAD. Multiple regression analysis revealed that SSc itself (B=0.171, 95% confidence interval 0.090~ 0.252, p<0.001) is an independent risk factor of reduced ABI. Correlation analysis showed MRSS was negatively correlated with ABI (r=-0.419, p=0.003).

SSc patients are more likely to develop PAD, which may be a kind of macrovascular disease in SSc. MRSS, a maker of disease activity, is associated with this peripheral artery involvement.