Department of Clinical Internistic Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
Int J Rheum Dis. 2021 Apr;24(4):502-509. doi: 10.1111/1756-185X.14002. Epub 2020 Oct 19.
Like other autoimmune diseases, systemic sclerosis (SSc) has been described to be associated with accelerated atherosclerosis (ATS). Before clinical manifestations of cardiovascular disease (CVD) occur, subclinical ATS can be investigated in different ways.
To evaluate the presence of subclinical ATS in a group of patients with SSc, and to identify different risk profiles among patients.
Subclinical ATS was reviewed in 43 SSc patients and 27 healthy controls, using 2 methods: carotid ultrasound and flow mediated dilation (FMD) of the brachial artery.
Plaques were statistically more frequent in SSc patients than in controls (65% vs 30%, P = .006); intima-media thickness of common carotid artery (CCA-IMT) resulted in statistically higher (median value 0.8 mm vs 0.55 mm; P < .0001) while FMD was significantly lower (median value 9% vs 14%; P = .0086) in patients compared to healthy controls. Among the SSc patients, thickening of CCA-IMT was significantly associated with the presence of diastolic dysfunction of left ventricle (absence of diastolic dysfunction: odds ratio [OR] 0.2, 95% CI 0.04-0.92, P = .038) and with a higher Framingham score (OR 1.3, 95% CI 1.03-1.6], P = .024). The diffuse cutaneous form was slightly protective against pathological FMD (OR 0.12, 95% CI 0.022-0.71, P = .019).
This study confirms the involvement of macrocirculation in SSc patients, detecting the presence of subclinical ATS markers more frequently in patients compared to healthy controls. Framingham score, diastolic dysfunction of left ventricle and limited cutaneous form of the disease appeared to be associated with a higher risk of developing ATS.
与其他自身免疫性疾病一样，系统性硬化症（SSc）已被描述为与动脉粥样硬化加速（ATS）相关。在心血管疾病（CVD）出现临床症状之前，可以通过不同的方法来研究亚临床 ATS。
评估一组 SSc 患者中亚临床 ATS 的存在，并确定患者之间不同的风险特征。
使用颈动脉超声和肱动脉血流介导的扩张（FMD）两种方法，对 43 名 SSc 患者和 27 名健康对照者进行亚临床 ATS 评估。
与对照组相比，SSc 患者的斑块更为常见（65%比 30%，P=0.006）；颈总动脉内膜中层厚度（CCA-IMT）结果显著更高（中位数 0.8mm 比 0.55mm；P<0.0001），而 FMD 显著更低（中位数 9%比 14%；P=0.0086）。在 SSc 患者中，CCA-IMT 增厚与左心室舒张功能障碍的存在显著相关（无舒张功能障碍：比值比[OR] 0.2，95%置信区间 0.04-0.92，P=0.038），且与Framingham 评分较高相关（OR 1.3，95%置信区间 1.03-1.6，P=0.024）。弥漫性皮肤型对病理性 FMD 有轻微的保护作用（OR 0.12，95%置信区间 0.022-0.71，P=0.019）。
本研究证实了 SSc 患者的大循环受累，与健康对照组相比，患者亚临床 ATS 标志物的存在更为常见。Framingham 评分、左心室舒张功能障碍和局限性皮肤型疾病似乎与 ATS 发展的更高风险相关。
