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Systemic sclerosis is an independent risk factor for ischemic heart disease, especially in patients carrying certain

Abdulla Watad1, Dennis McGonagle2, Nicola L Bragazzi3

  • 1Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Rheumatology Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.

European Journal of Internal Medicine
|July 5, 2020
PubMed

Insights

Systemic sclerosis (SSc) patients face a higher risk of ischemic heart disease (IHD). Certain autoantibodies, like anti-cardiolipin (aCL) and anti-beta2GPI, further elevate this risk, impacting SSc patient mortality.

Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Immunology

Background:

  • Systemic sclerosis (SSc) is associated with an increased prevalence of ischemic heart disease (IHD).
  • The role of SSc-related and antiphospholipid autoantibodies in IHD risk among SSc patients remains controversial.
  • This study investigates the association between SSc and IHD, its impact on mortality, and the influence of specific autoantibodies.

Purpose of the Study:

  • To determine the prevalence of IHD in patients with SSc compared to controls.
  • To assess the independent predictive value of SSc for IHD.
  • To evaluate the impact of IHD on SSc mortality.
  • To examine the role of SSc-related and antiphospholipid autoantibodies in IHD among SSc patients.

Main Methods:

  • A large cohort study utilized the Clalit-Health-Service (CHS) database.
  • 2431 SSc patients were compared with 12,710 age- and sex-matched controls.
  • Prevalence of IHD, SSc-associated mortality, and the impact of autoantibodies (anti-beta2GPI, aCL) were assessed.

Main Results:

  • IHD prevalence was significantly higher in SSc patients (20.4%) versus controls (15.0%).
  • SSc was an independent predictor of IHD (OR 1.91).
  • IHD in SSc patients was associated with higher mortality (HR 2.67).
  • Positivity for anti-beta2GPI (IgM) or aCL (IgA) increased IHD risk in SSc patients (OR 1.89 and 3.72, respectively).

Conclusions:

  • SSc patients exhibit an elevated risk of developing IHD.
  • Specific autoantibodies, namely anti-cardiolipin (aCL) and anti-beta2GPI, are identified as risk factors for IHD in SSc.
  • Routine monitoring and pre-emptive screening for IHD in SSc patients, particularly those with positive autoantibodies, are recommended.
Abstract

Keywords:
Antiphospholipids antibodiesAutoimmune diseasesIschemic heart diseaseSclerodermaSystemic sclerosis

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