title: Cardiovascular disease in systemic sclerosis.
abstract: Cardiovascular (CV) system involvement is a frequent complication of autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). It still remains unclear if a premature atherosclerosis (ATS) occurs even in systemic sclerosis (SSc). Although microvascular disease is a hallmark of SSc, in the last few years a number of studies highlighted a higher prevalence of macrovascular disease in SSc patients in comparison to healthy individuals and these data have been correlated with a poorer prognosis. The mechanisms promoting ATS in SSc are not fully understood, but it is believed to be secondary to multi-system organ inflammation, endothelial wall damage and vasculopathy. Both traditional risk factors and endothelial dysfunction have been proposed to participate to the onset and progression of ATS in such patients. In particular, endothelial cell injury induced by anti-endothelial antibodies, ischemia/reperfusion damage, immune-mediated cytotoxicity represent the main causes of vascular injury together with an impaired vascular repair mechanism that determine a defective vasculogenesis. Aim of this review is to analyse both causes and clinical manifestations of macrovascular involvement and ATS in SSc.
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cannarile
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Mirabelli
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Alunno
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Terenzi
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Luccioli
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gerli
authors.affiliation: Department of Medicine, Rheumatology Unit, University of Perugia, Via dal Pozzo 06132, Perugia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bartoloni
keywords: Atherosclerosis (ATS); cardiovascular (CV) disease; systemic sclerosis (SSc)