Macrovascular involvement in systemic sclerosis: Comorbidity or accelerated atherosclerosis?

Abstract

Introduction In the last decades, novel treatment strategies have reduced morbidity and mortality due to organ damage from autoimmune rheumatic diseases. However, longterm complications such as accelerated atherosclerosis have emerged as an important clinical problem and a determinant prognostic factor. Accelerated atherosclerosis and subsequent cardiovascular disease may complicate the long-term course of diseases such as systemic lupus erythematosus and rheumatoid arthritis. Both traditional and nontraditional cardiovascular risk factors may explain the high risk of cardiovascular disease. In these diseases, the development and acceleration of atherosclerosis can be facilitated by inflammation, cytokines, enhanced lipid oxidation, autoantibodies (principally antiphospholipid antibodies and antibodies to oxidized low-density lipoprotein), dyslipidemia, cigarette smoking, hyperhomocysteinemia, and steroid treatment. In addition, accelerated atherosclerosis is now considered a potential complication of systemic sclerosis (SSc).