Clinical and subclinical atherosclerosis in systemic sclerosis: consequences of previous corticosteroid treatment

Objective: To investigate the prevalence of clinical and subclinical atherosclerosis in systemic sclerosis (SSc) patients and its associated features. Methods: Fifty unselected SSc patients and 41 controls, matched for sex and age, were investigated for previous cardiovascular events, cardiovascular risk factors, and ultrasonographic features of subclinical atherosclerosis in the carotid arteries, that is intima-media thickness (IMT) > 0.9 mm or plaques. SSc patients were also investigated for disease features and previous treatment. Finally, blood samples were randomly selected from 27 patients and 18 controls to evaluate concentrations of amino-terminal propeptide of type III procollagen (PIIINP), transforming growth factor (TGF)-beta, hepatocyte growth factor (HGF), soluble interleukin-2 receptor (sIL-2R), IL-13, E-selectin, intercellular adhesion molecule (ICAM)-1, plasminogen activator inhibitor (PAI)-1, tissue plasminogen activator (t-PA), D-dimer, and prothrombin fragments (F1+2). Results: Previous cardiovascular events were recorded in three SSc patients and no controls (p > 0.05). Mean IMT (0.613 +/- 0.240 vs. 0.654 +/- 0.173 mm) did not differ between patients and controls (p > 0.05), but subclinical atherosclerosis was detected in 14/50 SSc patients and 4/41 controls (p = 0.036). At multiple logistic regression analysis, mean IMT was correlated with older age [p = 0.006; odds ratio (OR) 1.276, 95% confidence interval (CI) 1.043-1.516] and a higher cumulative corticosteroid intake (p = 0.017; OR 1.155, 95% CI 1.027-1.300). No correlation was found with any soluble marker of disease activity and of coagulation/fibrinolysis system activation. Conclusion: Our study confirms an increased prevalence of subclinical atherosclerosis in SSc patients and demonstrates a hitherto unknown association with corticosteroid cumulative dosage.