CAROTID INTIMA-MEDIA THICKNESS AND ENDOTHELIAL DYSFUNCTION IN SYSTEMIC SCLEROSIS (SSC)

Background: Increased macrovascular disease in SSc may be responsible of increased cardiovascular mortality in SSc. Brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness (IMT) are two indicators of subclinic cardiovascular disease and are frequently used as surrogate measures of subclinical atherosclerosis. Objectives: To determine wether functional and structural abnormalities of large vessels occur in SSc, we evaluated brachial FMD and carotid IMT in SSc patients. Methods: 35 patients with SSc (6 males and 29 females; 11 with diffuse and 24 with limitated disease) and 20 controls. Were studied Brachial artery FMD was assessed by method described by Celermejer, in all patients and in 13 control subjects. IMT was measured by using high resolution B-mode ultrasonography in all patients and control subjects. Traditional risk factor for atherosclerosis, as hypertension, dyslipidemia, smoke, were also assessed. Results: FMD was impaired in SSc patients (3.41 ± 4.56% vs 7.66 ± 4.24%; p<0.037). IMT was significantly elevated in subjects with SSc compared to healthy controls (0.93 ± 0.29 mm vs 0.81 ± 0.13 mm; p<0.005). Increased IMT was observed in 22% patients with impaired FMD and in none healthy subject with decreased FMD. No correlation was found between risk factors for atherosclerosis and the impairment of FMD or IMT in SSc patients. Conclusion: The impairment of endothelial function and the structural changes of large vessels are present in SSc and they not seem to be associated with traditional risk factors for atherosclerosis. Prospective studies including also clinical outcomes are needed to assess the features and significance of macrovascular involvement in SSc