Highlights
- •Systemic sclerosis (SSc) is an independent risk factor for ischemic heart disease (IHD).
- •SSc-linked autoantibodies have no impact on the risk of IHD.
- •SSc patients with positive anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) exhibited a higher risk of IHD than SSc patients without these antibodies.
Abstract
Background
A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis
(SSc) was reported. However, contrasting findings were published concerning the role
of SSc-related autoantibodies in IHD risk which remains controversial. The current
study explored the link between SSc and IHD, impact of putative links on SSc mortality
and the role of SSc-related and antiphospholipid autoantibodies in disease associated
IHD.
Methods
A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted
on 2431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD
was compared between patients diagnosed with SSc and age- and gender-matched controls.
The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD
was assessed.
Results
The prevalence rate of IHD was significantly higher in SSc than controls (20.4% vs 15.0%, p <0.001). At the multivariate analysis, SSc was an independent predictor of IHD with
an OR of 1.91 (95%CI 1.57–2.31, p < 0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI
2.03–3.53, p < 0.0001) than those without IHD. In SSc patients positivity for anti-beta2GPI (IgM-isotype)
or anti-cardiolipin (aCL) (IgA-isotype) represented a risk factor for IHD with an
OR 1.89 (95% 1.04–3.45, p = 0.0369) and OR of 3.72 (95% 1.25–11.11, p = 0.0184), respectively.
Conclusions
Patients with SSc are at higher risk for developing IHD with an additional risk for
the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion
is needed during routine patient follow-up and pre-emptive screening should be considered.
Keywords
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Article info
Publication history
Published online: June 30, 2020
Accepted:
June 25,
2020
Received in revised form:
June 5,
2020
Received:
April 26,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
