SSc patients often have plaque buildup in heart arteries
However, the condition may not be severe enough yet to diagnosis SCA, study finds
About 40% of systemic scleroderma (SSc) patients have subclinical coronary atherosclerosis (SCA), or the buildup of fatty deposits called plaques in the arteries that supply the heart without causing overt symptoms, according to a study in Italy.
Data also showed that most patients who experienced a major cardiovascular event over five years of follow-up had both SCA and pulmonary arterial hypertension (PAH), a condition characterized by higher-than-normal pressure in the arteries that carry blood to the lungs.
These findings suggest that SSc patients with both SCA and PAH may be at increased risk for serious cardiovascular problems such as heart attack and stroke, supporting the use of these conditions to identify high-risk SSc patients, the researchers noted.
The study, “Subclinical coronary atherosclerosis, detected by computer tomography with coronary calcium score, and the occurrence of major cardiovascular events at 5 years of follow-up in a cohort of patients with systemic sclerosis,” was published in the European Journal of Internal Medicine.
Scleroderma, also known as systemic sclerosis, is characterized by blood vessel abnormalities, increased inflammation, and tissue scarring. Cardio-pulmonary complications such as heart failure, PAH, and interstitial lung disease — characterized by lung scarring — are the leading causes of death among people with SSc.
However, the “presence of CVD [cardiovascular disease] has been shown to further increase mortality in SSc patients,” the researchers wrote, adding that discovering the main contributors to CVD in SSc may help to develop “more reliable tools for an accurate CV risk assessment in SSc in order to improve survival in these patients.”
Some small studies have suggested that SSc patients have higher rates of SCA, which can be detected by imaging tests, than the general population. When progressed to a severe form, coronary atherosclerosis can lead to heart failure.
Current study of SCA, plaque buildup in SSc patients
To know more about the frequency of SCA in SSc patients, as well as its potential link with cardiovascular events, a team of researchers in Italy looked at data from 67 adults with SSc who were followed at their clinic and who had no cardiovascular symptoms.
Patients’ mean age was 59.2 years, 90% were women, and they had been living with the disease for a mean of seven years.
Results showed that 39 SSc patients (42%) had SCA. They were significantly older (66 years vs. 52.6) and significantly more likely to have PAH (25% vs. 3%) and swallowing difficulties (86% vs. 61%) than those without SCA.
Patients with SCA also were significantly more likely to be given statins, which are medications used to lower cholesterol levels (36% vs. 8%), but less likely to be given the PAH treatment Tracleer (bosentan) (11% vs. 44%).
Rates of smoking and obesity, which are well-established risk factors for heart disease, did not differ significantly between patients with or without SCA. However, patients with SCA had significantly higher rates of other medical complications related to the heart and circulatory system.
These included carotid plaque (a plaque buildup in the vessels that supply blood to the brain and head), peripheral artery disease (blockage of vessels that carry blood to the legs), and metabolic syndrome (a constellation of symptoms like high blood pressure and high blood fat levels).
Patients with SCA also had significantly worse scores on several standardized measures of risk of cardiovascular disease relative to those without SCA.
‘Important implications for clinical practice’
“These results could have important implications for clinical practice,” the researchers wrote, suggesting that patients with worse risk scores may benefit from more aggressive treatment.
Over five years of follow-up, seven SSc patients (10.4%) experienced major cardiovascular events, such as heart attack or stroke. All of these patients had SCA, and 71% had PAH.
Those experiencing a major cardiovascular event also were significantly older, had significantly higher cardiovascular risk scores, and were appreciably more likely to have carotid plaque buildup and whole-body high arterial blood pressure.
In statistical models, the presence of PAH was the only factor-significant predictor of major cardiovascular events, being associated with a 10 times higher risk. The researchers noted, however, these models were limited by the small number of patients.
“This finding evidenced that PAH in SSc remains not only the leading cause of death, as widely described in previous studies, but also the main predictor of [major cardiovascular events],” the researchers wrote. “So, frequent and accurate screening for early detection of PAH … should be highly suggested to improve the survival of SSc patients.”
“Our data confirm an important cardiovascular impairment in SSc due to the presence of both SCA, mostly associated with the [metabolic syndrome] and other [plaque-related conditions] …, and PAH, the main life-threatening micro-vessels complications of SSc,” the team wrote.
Given that most patients who experienced a cardiovascular event had both SCA and PAH, the researchers suggested this combination of features may be useful for identifying patients at highest risk for such events, noting a need for more studies to test this idea.