Silent cardiovascular involvement in patients with diffuse systemic sclerosis: a controlled cross-sectional study.

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Vascular Biology

Background:

• Systemic autoimmune diseases like Systemic Sclerosis (SSc) are linked to increased cardiovascular morbidity and mortality due to atherosclerosis.
• SSc involves multisystem inflammation, endothelial damage, and vasculopathy, increasing atherosclerotic risk.
• Markers of endothelial dysfunction and atherosclerosis include asymmetric dimethylarginine (ADMA), arterial stiffness, carotid intima-media thickness (CIMT), and coronary flow reserve (CFR).

Purpose of the Study:

• To identify early cardiovascular involvement in Systemic Sclerosis patients using various endothelial and atherosclerosis markers.
• To assess subclinical atherosclerosis in SSc patients without overt cardiovascular disease symptoms.

Main Methods:

• A pilot study involving 20 diffuse SSc patients and 20 matched controls.
• Assessment included dipyridamole echocardiographic stress test for CFR, CIMT, arterial stiffness, and plasma ADMA levels.
• Patients had no clinical signs or symptoms of cardiovascular disease (CVD).

Main Results:

• SSc patients exhibited significantly elevated CIMT, pulse wave velocity, and stiffness index (β) compared to controls.
• Coronary flow reserve (CFR) was significantly lower in SSc patients.
• Plasma ADMA levels were significantly higher in SSc patients.

Conclusions:

• Systemic Sclerosis patients without clinical CVD show evidence of subclinical atherosclerosis.
• Early impairment of coronary microcirculation and macrovascular involvement are suggested by these findings.
• These markers may aid in early detection and management of cardiovascular risk in SSc.