Cardiovascular risk and prostanoids in systemic sclerosis.
OBJECTIVE
Systemic sclerosis (SSc) is characterized by Raynaud's phenomenon and frequent cutaneous ulcers. In patients resistant to oral treatments, i.v. prostanoids are usefully employed. Some anecdotal reports underlined the potential risk to develop cardiovascular ischemic complications in prostanoid-treated SSc patients.


METHODS
Fifty SSc patients (group 1: 44 female and 6 male, mean age 60.4 +/- 13.8SD) undergoing long-term prostanoid therapy (iloprost or alprostadil) and 42 control patients (group 2), treated with only oral drugs, were retrospectively evaluated for the cardiovascular risk and incidence of ischemic events.


RESULTS
Ischemic cardiovascular complications, i.e., myocardial infarction or stroke, were recorded in a significantly higher number of patients undergoing prostanoid treatment compared to controls (group 1: 7/50, 14% vs. group 2: 1/42, 2.4%; p=0.041). Interestingly, these events were significantly more frequent in the subgroup of patients with high cardiovascular risk (group 1: 6/10, 60% vs. group 2: 1/19, 5.2%; p=0.0026).


CONCLUSIONS
The present study suggests a possible role of prostanoid treatment in the pathogenesis of ischemic cardiovascular complications in SSc patients non-responders to oral vasodilators and high cardiovascular risk. Since prostanoids represent the first choice treatment of the most severe scleroderma ischemic cutaneous lesions, cardiovascular risk should be carefully evaluated in all patients before therapy.
Colaci
M
M
Chair and Rheumatology Unit, University of Modena e Reggio Emilia, Medical School; Policlinico di Modena, Modena, Italy.
Sebastiani
M
M
Giuggioli
D
D
Manfredi
A
A
Rossi
R
R
Modena
M G
MG
Ferri
C
C
D000368:Aged; D000527:Alprostadil / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016285:Iloprost / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011928:Raynaud Disease / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000188:drug therapy* / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D014665:Vasodilator Agents / Q000009:adverse effects*
D014665:Vasodilator Agents; D000527:Alprostadil; D016285:Iloprost