Key result
Diffuse systemic sclerosis was associated with subclinical atherosclerosis, evidenced by lower coronary flow reserve and higher plasma ADMA levels versus controls.
Why the study?
Do patients with diffuse systemic sclerosis without clinical cardiovascular disease have evidence of subclinical atherosclerosis and endothelial dysfunction compared to healthy controls?
Cross-Sectional (n=40)
Do patients with diffuse systemic sclerosis without clinical cardiovascular disease have evidence of subclinical atherosclerosis and endothelial dysfunction compared to healthy controls?
Patients with diffuse systemic sclerosis without clinical cardiovascular disease exhibit signs of subclinical atherosclerosis, including impaired coronary microcirculation and macrovascular involvement.
Answers are grounded in this paper and cite their sources.
Subclinical atherosclerosis markers in asymptomatic diffuse SSc warrant caution in risk assessment; leaves open need for prospective outcome studies.
OBJECTIVE: An association between systemic autoimmune diseases and atherosclerosis has been described in many connective tissue diseases, and this association is known to lead to increased cardiovascular morbidity and mortality. Systemic sclerosis (SSc) is characterized by multisystem organ inflammation, endothelial wall damage, and vasculopathy. There are many markers of endothelial dysfunction and/or atherosclerotic risk, such as asymmetric dimethylarginine (ADMA), arterial stiffness parameters, carotid intima-media thickness (CIMT), and coronary flow reserve (CFR) assessed by transthoracic echocardiography. The aim of this pilot study was to use various endothelial and atherosclerosis markers to identify early cardiovascular involvement in a group of SSc patients. METHODS: The study involved 20 patients (2 men and 18 women with a mean ± SD age of 52.96 ± 12.51 years) with diffuse SSc who had no signs or symptoms of cardiovascular disease (CVD) and 20 age- and sex-matched controls. All subjects underwent a dipyridamole echocardiographic stress test that included a determination of CFR and an evaluation of CIMT, arterial stiffness, and plasma ADMA levels. RESULTS: All of the arterial wall measurements of the patients with diffuse SSc were significantly different from those of the controls, and both right and left CIMT, pulse wave velocity, and stiffness index (β) were significantly elevated in the SSc patients compared to the healthy controls. Moreover, in patients with diffuse SSc, CFR was significantly lower (P = 0.0033) and plasma ADMA levels were higher (P < 0.0001) than in healthy controls. CONCLUSION: SSc patients without any clinical evidence of CVD seem to have had subclinical atherosclerosis, which was suggested by early impairment of coronary microcirculation and macrovascular involvement.
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Turiel et al. (2012) conducted a cross-sectional in Diffuse systemic sclerosis (n=40). Diffuse systemic sclerosis vs. Age- and sex-matched healthy controls was evaluated on Coronary flow reserve, carotid intima-media thickness, arterial stiffness, and plasma ADMA levels (p=0.0033 for CFR, <0.0001 for ADMA). Diffuse systemic sclerosis was associated with subclinical atherosclerosis, evidenced by lower coronary flow reserve and higher plasma ADMA levels versus controls.
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