Sklerodermalı hastalarda karotis intima-media kalınlığı ile subklinik aterosklerozun değerlendirilmesi
Abstract
Amaç: Enflamasyon ateroskleroz gelişiminde önemli bir role sahiptir. Enflamatuvar aktivitenin yüksek olduğu sistemik lupus eritematozus ve romatoid artrit gibi hastalıkları olan hastalarda ateroskleroz ve ateroskleroza bağlı gelişebilecek komplikasyon riski sağlıklı bireylere göre daha yüksektir. Bununla birlikte, birkaç çalışma sklerodermalı hastalarda çelişkili sonuçlar göstermiştir. Bu çalışmada karotis intima-media kalınlığı (KİMK) kullanılarak sklerodermalı hastalar ve kontrol grubu karşılaştırıldı.
Yöntemler: Çalışmaya skleroderma tanısı konan 30 hasta (ortalama yaş 51.3 ± 11.8 yıl) ve 30 sağlıklı gönüllü dahil edildi. Gruplar yaş, cinsiyet ve ateroskleroz için risk faktörleri açısından benzerdi.
Bulgular: Gruplar arasında yaş, cinsiyet, lipid düzeyi, hipertansiyon ve diabetes mellitus prevalansı açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Ortalama KİMK (skleroderma grubu: 0.070±0.011, kontrol grubu: 0.048±0.008, p<0.001) ve maksimum KİMK sklerodermalı hastalarda (skleroderma grubu: 0.076±0.013, kontrol grubu: 0.054±0.009, p<0.001) istatistiksel olarak anlamlı derecede yüksekti. Ayrıca ortalama KİMK ile hsCRP arasında (r=0.48, p<0.001) ve ortalama KİMK ile eritrosit sedimantasyon hızı arasında (r=0.50, p=0.007) skleroderma grubunda istatistiksel olarak anlamlı fark izlendi. Diffüz tip sklerodermalı hastalarda maksimum KİMK ve ortalama KİMK, lokalize sklerodermalı hastalara göre anlamlı olarak daha yüksekti (sırasıyla p değerleri 0.001 ve 0.011).
Sonuç: Sonuçlarımız, kontrol grubuna göre sklerodermalı hastalarda KİMK'nin daha yüksek olduğunu ve bunun artmış enflamatuar aktivite ile ilişkili olabileceğini göstermektedir.
Supporting Institution
Destekleyen kurum bulunmamaktadır.
References
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Assessment of subclinical atherosclerosis with carotid intima-media thickness in patients with scleroderma
Abstract
Aim: Inflammation has an important role in the development of atherosclerosis. The risk of atherosclerosis and its complications is higher for patients with diseases such as systemic lupus erythematosus and rheumatoid arthritis in whom inflammatory activity is high than for healthy individuals. However, several studies have shown conflicting results in patients with scleroderma. In this study, carotid intima-media thickness (CIMT) was compared in patients with scleroderma and a control group.
Methods: Thirty patients diagnosed with scleroderma (mean age 51.3 ± 11.8 years) and 30 healthy volunteers were included in the study. The groups were similar regarding age, gender, and risk factors for atherosclerosis.
Results: There was no statistically significant difference between the groups regarding age, gender, lipid level, hypertension, and diabetes mellitus prevalence (p>0.05). The mean CIMT (scleroderma group: 0.070±0.011, control group: 0.048±0.008, p<0.001) and the maximum CIMT (scleroderma group: 0.076±0.013, control group: 0.054±0.009, p<0.001) were statistically significantly higher in the patients with scleroderma. There was a statistically significant correlation between the mean CIMT and hsCRP (r=0.48, p<0.001); and the mean CIMT and the erythrocyte sedimentation rate (r=0.50, p=0.007) in the scleroderma group. The maximum CIMT and the mean CIMT were significantly higher in patients with diffuse type scleroderma compared to the patients with localized scleroderma (p values 0.001 and 0.011, respectively).
Conclusion: Our results show that CIMT is higher in patients with scleroderma compared to the control group, and this is associated with increased inflammatory activity.
References
- 1. Mallika V, Goswami B, Rajappa M. Atherosclerosis pathophysiology and the role of novel risk factors: a clinicobiochemical perspective. Angiology 2007;58:513-22.
- 2. Ridker PM, Cannon CP, Morrow D, et al. C-Reactive protein levels and outcomes after statin therapy. N Engl J Med 2005; 352: 20–8.
- 3. Fathi R, Marwick TH. Noninvasive tests of vascular function and structure: why and how to perform them. Am Heart J 2001;141:694–703.
- 4. Corretti MC, Anderson TJ, Benjamin EJ, et al. International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002; 39: 257–65.
- 5. Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997;146:483–94.
- 6. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age. The Muscatine Study. Circulation 2001;104:2815–9.
- 7. Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991;11:1245–9.
- 8. O'Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999; 340:14–22.
- 9. Soubrier M, Mathieu S, Dubost JJ. Atheroma and systemic lupus erythematosus. Joint Bone Spine 2007; 74:566-70.
- 10. Grover S, Sinha RP, Singh U, et al. Subclinical atherosclerosis in rheumatoid arthritis in India. J Rheumatol 2006; 33:244-7.
- 11. Aubry MC, Maradit-Kremers H, Reinalda MS, et al. Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis. J Rheumatol 2007; 34:937-42.
- 12. Szucs G, Tímár O, Szekanecz Z, et al. Endothelial dysfunction precedes atherosclerosis in systemic sclerosis--relevance for prevention of vascular complications. Rheumatology (Oxford) 2007; 46:759-62.
- 13. Bartoli F, Blagojevic J, Bacci M, et al. Flow-mediated vasodilation and carotid intima-media thickness in systemic sclerosis. Ann N Y Acad Sci 2007;1108:283-90.
- 14. Akram MR, Handler CE, Williams M, et al. Angiographically proven coronary artery disease in scleroderma. Rheumatology (Oxford) 2006; 45:1395-8.
- 15. Cheng KS, Tiwari A, Boutin A, et al. Carotid and femoral arterial wall mechanics in scleroderma. Rheumatology 2003; 42:1299–305.
- 16. Stafford L, Englert H, Gover J, Bertouch J. Distribution of macrovascular disease in scleroderma. Ann Rheum Dis 1998; 57:476–9.
- 17. Macedo R, Andretta M, Albers C, et al. Evaluation of carotid artery intima-media complex thickness as a marker of vascular damage secondary to accelerated atherogenesis in progressive systemic sclerosis Rev Col Bras Cir 2012;39:10-5.
- 18. Bartoli F, Angotti C, Fatini C, et al. Angiotensin-converting enzyme I/D polymorphism and macrovascular disease in systemic sclerosis. Rheumatology 2007; 46:772–5.
- 19. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.
- 20. Sattar N, McInnes IB. Vascular comorbidity in rheumatoid arthritis: potential mechanisms and solutions. Curr Opin Rheumatol 2005;17:286-92.
- 21. Urowitz MB, Bookman AA, Koehler BE, et al. The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 1976; 60:221-5.
- 22. Bruce IN, Urowitz MB, Gladman DD, Ibanez D, Steiner G. Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto Risk Factor Study. Arthritis Rheum 2003; 48:3159-67.
- 23. Manzi S, Meilahn EN, Rairie JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997;145: 408-15.
- 24. Fischer LM, Schlienger RG, Matter C, Jick H, Meier CR. Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. Am J Cardiol 2004;93:198e200.
- 25. Selzer F, Sutton-Tyrrell K, Fitzgerald SG, et al. Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus. Arthritis Rheum 2004;50:151-9.
- 26. Maksimowicz-McKinnon K, Magder LS, Petri M. Predictors of carotid atherosclerosis in systemic lupus erythematosus. J Rheumatol 2006;33:2458-63.
- 27. Au K, Singh MK, Bodukam V, et al. Atherosclerosis in Systemic Sclerosis- A Systematic Review and Meta Analysis. Arthritis Rheum 2011;63: 2078–90.
- 28. Veale DJ, Collidge TA, Belch JJF. Increased prevalence of symptomatic macrovascular disease in systemic sclerosis. Ann Rheum Dis 1995;54: 853–5.
- 29. de Groot E, Hovingh GK, Wiegman A, et al. Measurement of Arterial Wall Thickness as a Surrogate Marker for Atherosclerosis. Circulation 2004;109 [Suppl I]:III-33-8.
- 30. Lekakis J, Mavrikakis M, Papamichael C, et al. Short-term estrogen administration improves abnormal endothelial function in women with systemic sclerosis and Raynaud’s phenomenon. Am. Heart J 1998; 136: 905–12.
- 31. Schiopu E, Au KM, McMahon MA, et al. Prevalence of subclinical atherosclerosis is increased in systemic sclerosis and is associated with serum proteins: a cross-sectional, controlled study of carotid ultrasound. Rheumatology (Oxford) 2014; 53:704-13.
- 32. Tsifetaki N, Georgiadis AN, Alamanos Y, et al. Subclinical atherosclerosis in scleroderma patients. Scand J Rheumatol 2010;39:326-9.
- 33. Youssef P, Englert H, Bertouch J. Large vessel occlusive disease associated with CREST Syndrome and scleroderma. Ann Rheum Dis 1993;52:464–6.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Article |
| Authors | |
| Publication Date | February 28, 2022 |
| Submission Date | November 30, 2021 |
| Published in Issue | Year 2022 Volume: 32 Issue: 1 |
Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).