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Study suggests systemic sclerosis is an independent risk factor for atherosclerosis

Age and hypertension contribute to coronary calcification -- similar to general population

A new study by researchers in Hong Kong suggests that systemic sclerosis is an independent determinant for moderate to severe coronary calcification or atherosclerosis.

Conventional cardiovascular risk factors such as age and hypertension predispose patients with systemic sclerosis to plaque build-up in the heart arteries similar to the general population. Details of this study are now available in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR).

Systemic sclerosis, also known as scleroderma, is a connective tissue disease which is characterized by sclerodermatous (hardening of tissue due to increased collagen deposits) skin changes, Raynaud's phenomenon, and internal organ fibrosis. The ACR estimates that systemic sclerosis affects 49,000 Americans and a prior U.S. study approximated the prevalence to be 25 per 100,000 individuals. While medical evidence suggests that coronary artery disease (CAD) is increasing in patients with systemic sclerosis, the prevalence of coronary calcification (a measure of coronary artery atherosclerosis) and its risk factors remain unknown.

In the current study a research team, led by Dr. Mo Yin Mok of the Queen Mary Hospital and the University of Hong Kong, recruited 53 patients with systemic sclerosis (50 female, 3 male) and 106 healthy controls to examine coronary artery calcium scores (CACS) and cardiovascular risk factors. Disease activity score, antiphospholipid antibodies, C-reactive protein, and erythrocyte sedimentation rate were also measured for scleroderma patients.

Researchers found that 57% of patients with systemic sclerosis had moderate to severe coronary calcification (CACS greater than 101) compared to only 29% of controls. Scleroderma patients also had significantly lower LDL-cholesterol, HDL-cholesterol, and diastolic blood pressure compared to healthy controls. In addition, compared to the control group, roughly one-third of patients had a low body mass index (BMI) and would be considered underweight according to recommended BMI cutoffs for Asian populations.

Regression analysis also showed that systemic sclerosis was an independent risk factor for coronary artery calcification (odds ratio of 10.89), and disease duration was associated with more severe atherosclerosis. The results of this study concur with previous reports of increased atherosclerosis as determined by angiography in patients with systemic sclerosis. "Our findings show that systemic sclerosis patients have an 11-fold increased risk for developing moderate to severe coronary calcification after adjustment for normal cardiovascular risk factors," concluded Dr. Mok. "CAD is a major global health concern, and further studies should explore modifiable disease-specific risk factors in scleroderma patients that could inhibit coronary calcification in this population."

This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of the articles may contact

Full citation:

"Systemic Sclerosis is an Independent Risk Factor of Increased Coronary Artery Calcium Deposition." Mo Yin Mok, Chak Sing Lau, Sonny Sau Hin Chiu, Annette Wai Kwan Tso, Yi Lo, Lawrence Siu Chun Law, Ka Fung Mak, Woon Sing Wong, Peh Lan Khong, Karen Siu Ling Lam. Arthritis & Rheumatism; Published Online: April 28, 2011 (DOI: 10.1002/art.30283).

About the Journal

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a division of the College, and covers all aspects of inflammatory disease. The American College of Rheumatology ( is the professional organization who share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. For details, please visit 10.1002/(ISSN)1529-0131.

About Wiley-Blackwell

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit or our new online platform, Wiley Online Library (, one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.

Dawn Peters | EurekAlert!
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