Microvascular damage is associated with carotid wall structural changes in Systemic Sclerosis: a capillaroscopy and ultrasound‐based observational study

Introduction 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. Methods In this cross‐sectional study, 165 SSc patients 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 carotid level. Results Mean bilateral cIMT was 0.83±0.17 mm, with 52.1% of patients exhibiting a cIMT≥0.9 mm, 46.7% had carotid plaques (20.6% bilateral). A non‐scleroderma pattern was found in 12.7%, whereas early (21.8%), active (30.3%) and late pattern (35.1%) 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 pathological cIMT and plaque at any side, where age and systolic blood pressure (SBP) revealed a stronger predictive effect. Conclusion 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.