Objective. Systemic sclerosis (SSc) is characterized by calcification, vasculopathy, and endothelial wall damage, all of which can increase the risk of developing atherosclerosis and cardiovascular disease. The aim of this study was to perform a systematic review and meta-analysis to determine whether the risk of atherosclerosis is increased in SSc patients compared to healthy individuals.
Methods. A systematic search was performed to identify studies published in PubMed and the Cochrane database up to May 2010, and recently published abstracts were also reviewed. Two reviewers independently screened articles to identify studies comparing the rate of atherosclerosis in SSc patients to that in healthy controls. The studies utilized one of the following methods: angiography, Doppler ultrasound to assess plaque and carotid intima-media thickness (IMT), computed tomography, magnetic resonance imaging, flowmediated vasodilation (assessed as the FMD%), the ankle-brachial index, or autopsy. For carotid IMT and FMD% values, we computed a pooled estimate of the summary mean difference and explored predictors of carotid IMT using random-effects meta-regression.
Results. Of the 3,156 articles initially identified, 31 were selected for systematic review. The metaanalysis included 14 studies assessing carotid IMT and 7 assessing brachial artery FMD%. Compared to healthy controls, SSc patients had a higher prevalence of coronary atherosclerosis, peripheral vascular disease, and cerebrovascular calcification. Meta-analysis showed that SSc patients had increased carotid IMT (summary mean difference 0.11 mm, 95% confidence interval [95% CI] 0.05 mm, 0.17 mm; P โซุโฌ 0.0006) and lower FMD% (summary mean difference ุ3.07%, 95% CI ุ5.44%, ุ0.69%; P โซุโฌ 0.01) compared to controls. There was marked heterogeneity between the studies, which was mainly attributable to variations in disease duration and differences in the mean/median age between SSc patients and controls.
Conclusion. Patients with SSc have an increased risk of atherosclerosis compared to healthy subjects. Further studies should elucidate the mechanism of this increased risk.
Atherosclerosis is the hallmark of cardiovascular disease and the leading cause of mortality in the world (1). Much of the mortality attributed to cardiovascular disease comes from myocardial infarctions and strokes. The association between autoimmune diseases and atherosclerosis is well described in many connective tissue diseases, such as systemic lupus erythematosus and rheumatoid arthritis (2,3), and is linked to increased cardiovascular morbidity and mortality in these patients (2,3). Mechanisms by which atherosclerosis is promoted in connective tissue diseases remain unknown, but it is believed to occur secondary to chronic inflammation (4,5), altered lipid profiles and function (6,7), develop-Dr.