title: A critical view on cardiovascular risk in systemic sclerosis.
abstract: Systemic Sclerosis (SSc) is an autoimmune disorder characterized by microvascular injury and diffuse fibrosis of the skin and internal organs. While macrovascular disease and higher risk for cardiovascular events are well documented in other systemic rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus, the presence and extent of atherosclerosis among patients with SSc is yet to be established. Primary cardiac involvement, due to impairment of coronary microvascular circulation and myocardial fibrosis, considerably affects prognosis and life expectancy of individuals with SSc, representing one of the leading causes of death in this population. On the other hand the existence and prevalence of atherosclerotic coronary disease remains an issue of debate as studies comparing structural and morphological markers of atherosclerosis and cardiovascular events between SSc patients and the general population have yielded controversial results. The aim of this review is to summarize recent literature about the prevalence of cardiovascular disease in SSc, review the surrogate markers of CVD that have been evaluated and examine whether common pathogenic mechanisms exist between SSc and macrovascular disease.
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
authors.forename: Antonios
authors.initials: A
authors.lastname: Psarras
authors.affiliation: Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
authors.forename: Stergios
authors.initials: S
authors.lastname: Soulaidopoulos
authors.affiliation: Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Garyfallos
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
authors.forename: George
authors.initials: G
authors.lastname: Kitas
authors.affiliation: Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, 54642, Thessaloniki, Greece. dimitroul@hotmail.com.
authors.forename: Theodoros
authors.identifier: http://orcid.org/0000-0002-0364-1642
authors.initials: T
authors.lastname: Dimitroulas
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015995:Prevalence; D012306:Risk; D012595:Scleroderma, Systemic / Q000150:complications*
keywords: Atherosclerosis; CVD; Systemic sclerosis