Abstract
ObjectiveThe aim of this study was to assess cardiovascular involvement in patients with connective tissue disease (CTD), and determine whether interstitial lung disease (ILD) in these patients is associated with elevated cardiovascular risk.MethodsThis study evaluated a retrospective cohort of 436 CTD patients admitted to a large teaching hospital in Zhejiang province, China, along with an additional 436 participants of an annual community health screening conducted in the physical examination center who served as age- and gender-matched controls. Demographic, clinical, serologic and imaging characteristics, as well as medications used by each participant were recorded. Cardiovascular involvement was defined by uniform criteria. Correlations between clinical/serologic factors and cardiovascular involvement were determined by univariate and multivariate analyses.ResultsCTD patients had a significantly higher cardiovascular involvement rate than controls (64.7% vs 23.4%), with higher rates of diabetes, hypertension, and hyperlipidemia, elevated systolic and diastolic pressures, C-reactive protein, total cholesterol, and low-density lipoprotein cholesterol, and lower albumin and high-density lipoprotein cholesterol (all p < 0.05). Furthermore, CTP patients with cardiovascular involvement were significantly older, had higher systolic and diastolic pressures, C-reactive protein, glucose, and uric acid, higher rates of diabetes, hypertension, and use of moderate- to high-dose glucocorticoids, and longer disease duration compared to patients without involvement (all p < 0.05). Moreover, CTD in patients with cardiovascular involvement was more likely to be complicated by ILD (p < 0.01), which manifested as a higher alveolar inflammation score (p < 0.05). In the multivariate analysis, cardiovascular involvement in CTD patients was associated with age, systolic pressure, body mass index, uric acid, disease duration > 2 years, use of moderate- to high-dose glucocorticoids, and ILD with a high alveolar inflammation score.ConclusionCardiovascular involvement is increased in CTD patients, and is associated with ILD with a higher alveolar inflammation score. Thus, early-stage echocardiography and CT scans should be used to detect potential cardiovascular complications in these patients.
Highlights
Connective tissue diseases (CTDs) represent a spectrum of systemic autoimmune diseases characterized by the presence of circulating autoantibodies and significant autoimmunemediated organ damage
CTD in patients with cardiovascular involvement was more likely to be complicated by interstitial lung disease (ILD) (p < 0.01), which manifested as a higher alveolar inflammation score (p < 0.05)
Cardiovascular Involvement in Connective Tissue Disease multivariate analysis, cardiovascular involvement in CTD patients was associated with age, systolic pressure, body mass index, uric acid, disease duration > 2 years, use of moderateto high-dose glucocorticoids, and ILD with a high alveolar inflammation score
Summary
Connective tissue diseases (CTDs) represent a spectrum of systemic autoimmune diseases characterized by the presence of circulating autoantibodies and significant autoimmunemediated organ damage. New promising therapies are emerging, CTDs are still considered incurable, for patients with various complications. One of the major causes of morbidity and mortality of CTD patients is cardiovascular involvement [1]. The early phases of cardiovascular disease (CVD) are typically asymptomatic, occur at younger ages, and are only characterized by specific risk factors [2, 3]. CVD is relatively difficult to detect in CTD patients prior to serious, or even fatal, events. A regular assessment of CVD risk factors has been recommended in patients presenting with systemic lupus erythematous (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc) [4, 5]
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