title: Cardiovascular involvement in connective tissue disease: the role of interstitial lung disease.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  CTD 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.
  
  
  CONCLUSIONS
  Cardiovascular 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.
authors.affiliation: Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: XiaoBing
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: MeiNa
authors.initials: M
authors.lastname: Lou
authors.affiliation: Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: Yongji
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: WenJing
authors.initials: W
authors.lastname: Ye
authors.affiliation: Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: ZhiYong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Radiology Department, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: Xiufen
authors.initials: X
authors.lastname: Jia
authors.affiliation: Department of Preventive Medicine, School of Environmental Science and Public Health, Wenzhou Medical University, Zhejiang, China.
authors.forename: HongYing
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Rheumalogy, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: XiaoChun
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Pneumology Department, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
authors.forename: LiangXing
authors.initials: L
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D003240:Connective Tissue Diseases / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk