Traditional cardiovascular risk factors and atherosclerosis in patients with systemic sclerosis

Objective. To assess frequency of traditional cardiovascular risk factors, clinical and subclinical atherosclerosis features in patients with systemic sclerosis (SS).

Material and methods. 70 pts with definite diagnosis of SS ( 66 female and 4 male with mean age 46±10,8 years) were included. Control group consisted of 50 relatively healthy volunteers without systemic rheumatic diseases and Raynaud’s phenomenon, matched on sex and age. Classic risk factors of atherosclerosis were analyzed. Total coronary risk (TCR) (10-years risk of cardiovascular catastrophes development) was assessed with Framingham scale. Carotid sonographic examination with intima-media complex thickness (IMT) measurement using a 7.5 MHz frequency linear transducer was performed in 60 SS pts and 45 volunteers with Voluson 730 Expert apparatus (Austria).

Results. Frequency of traditional cardiovascular risk factors and TCR was comparable in in SS pts and control. Menopause was more frequent in SS pts (p=0,005). Coronary heart disease was more frequent SS pts (13% versus 2%, p<0,05). Mean triglyceride level in SS pts was significantly higher than in the control group (p<0,001). There was a tendency to increase of IMTmax and IMT thickening in SS compared with control group. Atherosclerotic plaques were present in 10% of SS pts and were absent in control group. IMTmean and IMTmax positively correlated with age of SS pts (p<0,001; p<0,001) and TCR (p<0,001, p=0,001). IMTmean correlated with disease duration (p<0,05) and cholesterol level (p<0,05) in SS pts.

Conclusion. Frequency of clinical and subclinical atherosclerosis features in SS pts was higher than in the control group but frequency of main cardiovascular risk factors did not significantly differ. It is possible that generalized SS angiopathy predisposes to vascular atherosclerosis development in SS pts.

1. Гусева Н.Г. Системная склеродермия. В книге: Сигидин Я.А., Гусева Н.Г, Иванова М.М. Диффузные болезни соединительной ткани. М., «Медицина», 2004, 341-487.

2. LeRoy C.E. Systemic sclerosis: a vascular perspective. Rheum. Dis. Clin. N. Am. 1996, 22, 675–695.

3. Davignon J., Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation, 2004, 109, III-27 – III-32.

4. Matucci-Cerinic M., Valentini G., Sorano G.G. et al. Blood coagulation, fibrinolysis and markers of endothelial dysfunction in systemic sclerosis. Sem. Arthr. Rheum., 2003, 32, 285–292.

5. Shoenfeld Y., Gerli R., Doria A. et al. Accelerated atherosclerosis in autoimmune rheumatic diseases. Circulation, 2005,112, 3337-3347.

6. Sherer Y., Shoenfeld Y. Mechanisms of disease: atherosclerosis in autoimmune diseases. Nat. Clin. Pract. Rheumatol., 2006, 2(2), 99-106.

7. Ho M., Veale D., Eastmond C. et al. Macrovascular disease and systemic sclerosis. Ann. Rheum. Dis., 2000, 59, 39-43.

8. Matucci Cerinic M., Fiori G., Grenbaum E., Shoenfeld Y. Macrovascular disease in systemic sclerosis. In: Furst D, Clements P, eds. Systemic Sclerosis. Baltimore, Md: Lippincott Williams and Wilkins, 2003, 241.

9. Veale D.J., Collidge T.A., Belch J.J. Increased prevalence of symptomatic macrovascular disease in systemic sclerosis. Ann. Rheum. Dis., 1995, 54, 853-855.

10. Youssef P., Englert H., Bertouch J. Large vessel occlusive disease associated with CREST syndrome and scleroderma. Ann. Rheum. Dis., 1993, 52, 464- 466.

11. Youssef P., Brama T., Englert H. et al. Limited scleroderma is associated with increased prevalence of macrovascular disease. J.Rheumatol., 1995, 22 (3), 469-472.

12. Stafford L., Englert H., Gover J. et al. Distribution of macrovascular disease in scleroderma. Ann. Rheum. Dis., 1998, 57(8), 476-479.

13. Taylor M.H., McFadden J.A., Bolster M.B. et al. Ulnar artery involvement in systemic sclerosis (scleroderma). J. Rheumatol., 2002, 29(1), 102- 106.

14. Cheng K.S., Tiwari A., Boutin A. et al. Carotid and femoral arterial wall mechanics in scleroderma. Rheumatology, 2003, 42, 1299–1305.

15. Moyssakis I., Gialafos E., Vassiliou V. et al. Aortic stiffness in systemic sclerosis is increased independently of the extent of skin involvement. Rheumatology, 2005, 44, 251–254.

16. Sulli A., Ghio M., Bezante G.P. et al. Blunted coronary flow reserve in systemic sclerosis. Rheumatology (Oxford), 2004, 43(4), 505-509.

17. Szucs G., Timar O., Szekanecz Z. et al. Endothelial dysfunction precedes atherosclerosis in systemic sclerosis--relevance for prevention of vascular complications. Rheumatology (Oxford), 2007, 46 (5), 759-762.

18. Bryan C., Howard Y., Brennan P. et al. Survival following the onset of scleroderma: results from a retrospective inception cohort study of the UK patient population. Br. J. Rheumatol., 1996, 35, 1122-1126.

19. Jacobsen S., Halberg P., Ullman S. Mortality and causes of death of 344 Danish patients with systemic sclerosis (scleroderma). Br. J. Rheumatol., 1998, 37, 750-755.

20. Subcommittee for scleroderma criteria of the American Rheumatism Association diagnostic and therapeutic criteria committee. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthr. Rheum., 1980, 23, 581-590.

21. Kannel W.B., Castelli W.P., McNamara M.P. The coronary profile: 12-year follow-up in Framingham Study. J. Occup. Med., 1987, 9, 611-619.

22. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation, 2002, 106, 3143.

23. World Health Organization. International Society of Hypertension Guidelines for management of hypertension. Guidelines Subcommittee. J. Hypertens., 1999, 17, 151-183.

24. Hulley S., Grady D., Bush T. et al. Randomized trial of Estrogen Plus World Health Organization: Report of WHO Consultation: Definition, Diagnosis and Classification of Diabetes Mellitus and its Complication. Geneva, 1999.

25. Перова Н.В., Косматова О.В. Простой метод оценки снижения суммарного коронарного риска при лечении гипертонии и гиперлипидемии. Кардиология, 2002, 3, 23-25.

26. Haward G., Sharrett A.R., Heiss G. et al. Carotid artery intima-media thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke, 1993, 24, 1297-1304.

27. Ianuzzi A., Michele M.D., Panico S. et al. Radical-Trapping Activity, Blood Pressure and Carotid Enlargement in women. Hypertension, 2003, 41, 289-296.

28. Rossi R., Grimaldi T., Origliani G. et al. Menopause and cardiovascular risk. Pathophysiol. Haemost. Thromb., 2002, 32, 325-328.

29. Pines A., Bornstein N.M., Shapira I. Menopause and ischemic stroke: basic, clinical and epidemiological considerations. The role of hormone replacement. Human Reproduction Update, 2002, 8(2), 161-168.

30. Maturana M.A., Irigoyen M.C., Spritzer P.M. Menopause, estrogens, and endothelial dysfunction: current concepts. Clinics, 2007, 62(1), 77-86.

31. Панафидина Т.А., Попкова Т.В., Алекберова З.С. и др. Значение факторов риска и С-реактивного белка в развитии атеросклероза у женщин с СКВ. Клинич. мед., 2006, 10, 49-54

32. Попкова Т.В., Алекберова З.С., Решетняк Т.М. и др. Липид-белковые показатели системы транспорта холестерина крови у больных системной красной волчанкой в зависимости от антифосфолипидного синдрома. Научно-практич. ревматол., 2001, 5, 12-18.

33. Pignone., Scaletti C., Matucci -Cerinic M. et al. Anti-endothelial cell antibodies in systemic sclerosis: significant association with vascular involvement and alveolo-capillary impairment. Clin. Exp. Rheumatol., 1998, 16, 527–532.

34. Homocysteine concentration in primary and systemic sclerosis associated Raynaud’s phenomenon. J. Rheumatol., 2000, 27, 2621–2623.

35. Andersen G.N., Caidahl K., Kazzam E. et al. Correlation between increased nitric oxide production and markers of endothelial activation in systemic sclerosis: findings with the soluble adhesion molecule E selectin, intercellular adhesion molecule 1 and vascular adhesion molecule 1. Arthr. Rheum., 2000, 43, 1085–1093.

36. Herrick A., Matucci Cerinic M. The emerging problem of oxidative stress and the role of antioxidants in systemic sclerosis. Clin. Exp. Rheumatol., 2001, 19, 1–4.

37. Shovman O., Levy Y., Gilburd B. et al. Antiinflammatory and immunomodulatory properties of statins. Immunol. Res., 2002, 25, 271–285.