Microvascular Damage Is Associated With Carotid Wall Structural Changes in Systemic Sclerosis: A Capillaroscopy and Ultrasound-Based Observational Study

Systemic sclerosis (SSc) is characterized by cardiovascular risk excess not fully explained by traditional factors. Whether the severity of microvascular damage correlates with structural subclinical atherosclerosis remains unclear. We investigated the relationship between nailfold videocapillaroscopy (NVC) abnormalities and carotid ultrasound wall alterations in SSc.

In this cross-sectional study, 165 patients with SSc underwent NVC and carotid ultrasound. NVC patterns were collected, and specific abnormalities were graded semiquantitatively. Carotid intima-media thickness (cIMT) and atherosclerotic plaques (unilateral/bilateral) were evaluated. In patients with scleroderma pattern, associations were explored using univariate and ordinal trend analyses. Multivariable logistic regression models were employed to explore independent predictors of atherosclerosis at the carotid level.

Mean bilateral cIMT was 0.83 ± 0.17 mm, with 52.1% of patients exhibiting a cIMT ≥0.9 mm, and 46.7% had carotid plaques (20.6% bilateral). A nonscleroderma pattern was found in 12.7%, whereas early (21.8%), active (30.3%), and late (35.1%) patterns were more prevalent. No associations were found among NVC findings and both cIMT and the plaque at any side. Late pattern (P = 0.021), avascular areas (P = 0.009), and capillary density reduction (P = 0.021) were associated with bilateral plaques. In multivariable models, late NVC pattern was associated with bilateral plaques, whereas no independent association was found for pathologic cIMT and plaque at any side, for which age and systolic blood pressure (SBP) revealed a stronger predictive effect.

More severe structural microangiopathy in SSc is associated with bilateral plaques at carotid level. However, traditional risk factors, like age and SBP, remain key determinants of cIMT and plaques at any side.