Atherosclerosis in Vietnamese patients with systemic sclerosis and its relationship to disease and traditional risk factors

摘要

Objective The aim of this study was to determine the frequency of clinical and subclinical atherosclerosis in Vietnamese patients with SSc and the risk factors for subclinical atherosclerosis. Methods A case-control study of 46 patients with SSc who met the ACR criteria for the disease and 42 healthy age- and sex-matched controls of Kinh ethnicity was conducted. Clinical data including cardiovascular disease (CVD) events were collected. Serum levels of blood lipids and high-sensitivity CRP were determined. Carotid artery intima-media thickness (IMT) and carotid plaques were measured by carotid Doppler ultrasonography. Results Patients with SSc, of whom 96 had dcSSc, reported a higher number of CVD events compared with the controls (21.7 vs 0; P = 0.0065). They exhibited low serum levels of high-density lipoprotein cholesterol and high levels of total cholesterol compared with controls (P = 0.01 and P = 0.03, respectively). Common carotid artery IMT was significantly higher in SSc patients compared with controls mean (s.d.): 0.61 (0.12) vs 0.47 (0.07) mm; P < 0.0001. Carotid artery IMT in SSc showed significant positive correlations with age, disease duration, total cholesterol and low-density lipoprotein cholesterol (P < 0.05). Thirteen patients with SSc (28.3) but no controls had carotid atherosclerotic plaques. Patients with plaque had a higher mean modified Rodnan skin score and higher mean IMT compared with patients without plaque. Conclusion We confirmed an increased risk of CVD events and signs of subclinical atherosclerosis in patients with SSc of Kinh ethnicity and both traditional and disease-related risk factors for CVD. Lay Summary What does this mean for patients? SSc is an autoimmune disease that can cause thickening and scarring of tissue, in addition to damage to blood vessels. It can affect the skin, heart, lungs and other internal organs. Heart problems are more common in people with SSc. They are often related to atherosclerosis, whereby arteries become blocked with fatty substances or plaques, leading to coronary heart disease. It is likely that the rate of undetected heart problems in people with SSc is very high. One way to look for undetected atherosclerosis is to measure the thickness of the carotid artery using a carotid intima-media thickness (IMT) test. The IMT test is performed using US imaging. It is a cheap and non-invasive way of predicting heart disease. We examined carotid artery thickness and plaques in 44 people with SSc and 42 healthy people. We found more signs of atherosclerosis and increased risk of heart problems in people with SSc compared with healthy people. We suggest that people with SSc should be assessed using carotid US to detect the risk of heart disease. This could be especially useful in developing countries with low budgets for health care. The results would help doctors to find suitable treatments to reduce ill health and death rates in people with SSc.