Arterial stiffness is increased in systemic sclerosis: a cross-sectional comparison with matched controls

Increased arterial stiffness is a predictor of cardiovascular and all-cause mortality. Atherosclerosis may be increased in systemic sclerosis (SSc). Our aims were to determine if arterial stiffness is elevated and to evaluate correlates of arterial stiffness in SSc.

We carried out two studies: 1. a comparison of arterial stiffness in 40 SSc patients free from cardiovascular disease or significant vascular manifestations of SSc and 40 healthy controls (HC), and 2. an analysis of determinants of arterial stiffness in 80 SSc patients free from cardiovascular disease.

In Study 1, the groups were well-matched for age (52.2 vs. 50.0 years, p=0.432) and sex (80% female in both). SSc patients had higher augmentation index (AIx) than HC (31.0% [IQR 25.7-38.7] vs. 23.8% [IQR 13.5- 30.1], p<0.001). Pulse wave velocity (PWV) was also higher, however this did not reach statistical significance (6.9 m/s [IQR 6.0-8.3] vs. 6.5 m/s [IQR 6.1-7.4], p=0.275). In Study 2, age (p<0.001) and calcium channel blocker (CCB) therapy (p=0.016) were independently associated with higher AIx; and age (p<0.001), disease duration (p=0.042) and systolic blood pressure (p=0.001) with higher PWV.

SSc patients had higher AIx than HC. The paradoxical association between CCB therapy and higher AIx could reflect generalised vasculopathy rather than atherosclerotic disease. Prospective studies in larger cohorts are warranted to clarify this point and elucidate other determinants of arterial stiffness in SSc.