Background: Patients with systemic sclerosis (SSc) may be burdened by increased cardiovascular (CV) risk due to accelerated atherosclerosis (ATS) due to systemic inflammation, and vascular impairment.

Objectives: To evaluate CV risk in SSc patients SSc compared to healthy controls (HC) and to assess its association with disease-specific features.

Methods: 92 patients with SSc (81 females; mean age 52; mean disease duration 6.8 years; dcSSc: n=28, lcSSc: n=64) and 197 HC (147 females, mean age 56.7) were included, all with no history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events). Disease activity and organ involvement were evaluated in SSc. In all participants comorbidities and current treatment were recorded, examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (by densitometry (DXA) and bioelectrical impedance analysis (BIA)) were performed. The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE, charts for the European population) and its modifications: SCORE multiplied by the coefficient 1.5 (mSCORE), and SCORE2.

Results: SSc patients had a trend to higher prevalence of dyslipidemia (p=0.063) and significantly more often prediabetes (p<0.001) than HC, but a comparable prevalence of arterial hypertension, diabetes mellitus, and current smoking to HC. Nevertheless, SSc used significantly more frequently antihypertensives HC (p<0.001), including calcium channel blockers (indicated for Raynaud’s phenomenon). SSc had significantly increased prevalence of carotid artery disease, more unfavorable CIMT and ABI (p<0.05), and only a trend to lower SCORE and overall CV risk based on SCORE but no significant difference in SCORE2 compared to HC.

On the contrary, the overall CV risk based on US examination was significantly higher in SSc. A comparison of calculated CV risk with US examination showed inaccuracy of the CV risk scoring systems in SSc (Figure 1). Nevertheless, SCORE2 underestimated the real CV risk significantly less than SCORE (p=0.043), while SCORE2 vs. mSCORE and SCORE vs. mSCORE were comparable. In SSc, the CV risk and markers of subclinical ATS were associated especially with age, HbA1c, disease duration, and mean arterial pressure (p<0.05 for all).

Conclusion: This cross-sectional case-control study in SSc patients demonstrated a significantly increased risk of subclinical ATS in SSc compared to HC, although there was an opposite trend in CV risk estimated by calculated SCORE. The CV risk in SSc was associated especially with age, disease duration, and HbA1c levels, among others. Scoring systems underestimated the CV risk (when compared to ultrasound findings), while SCORE2 was significantly more accurate than SCORE.

REFERENCES: NIL.

Acknowledgements: Supported by MHCR (023728; NV18-01-00161A; NU21-01-00146).

Disclosure of Interests: None declared.