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STUDY OF ATHEROSCLEROTIC CHANGES IN THE CAROTID
ARTERIES IN PATIENTS WITH SYSTEMIC SCLERODERMA
Ganieva N.A.
Djuraeva E.R.
Dwivedi K.
Tashkent Medical Academy, Tashkent, Uzbekistan
https://doi.org/10.5281/zenodo.15003720
Introduction.
Autoimmune diseases, including systemic sclerosis (SSc), are
associated with various complications, with vascular issues being among the
most significant contributors to morbidity and mortality. One of the leading
causes of mortality in patients with autoimmune diseases, particularly in
systemic sclerosis, is the development of vascular complications [2]. These
complications are primarily driven by the early onset and rapid progression of
atherosclerotic lesions in the vascular system. Systemic sclerosis is
characterized by immune-mediated damage to small blood vessels, which can
lead to endothelial dysfunction, impaired blood flow, and progressive fibrosis of
vascular tissues. The abnormal vascular remodeling and endothelial injury in
SSc patients create an environment conducive to the development of
atherosclerosis, a condition where plaques of fat, cholesterol, and other
substances accumulate on the arterial walls [1]. This leads to narrowing and
hardening of the arteries, which can reduce blood flow and increase the risk of
cardiovascular events such as stroke, myocardial infarction, and other life-
threatening conditions. The pathophysiology of accelerated atherosclerosis in
SSc remains incompletely understood but is believed to involve a complex
interaction between endothelial cell damage, inflammation, immune system
dysregulation, and impaired vascular repair mechanisms [3]. Moreover, SSc
patients often present with a combination of traditional cardiovascular risk
factors (such as hypertension and dyslipidemia) and disease-specific factors,
making them particularly vulnerable to the early development of atherosclerotic
changes [5]. The rapid progression of atherosclerosis in this population, coupled
with the associated vascular complications, emphasizes the need for early
detection and proactive management of cardiovascular risk factors in patients
with systemic sclerosis. Monitoring vascular health, identifying early
atherosclerotic changes, and implementing preventive measures can play a
crucial role in reducing cardiovascular-related morbidity and mortality in SSc
patients [4].
Objective:
To investigate the features of carotid artery damage in systemic
scleroderma.
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Materials and Methods.
The study included 88 female patients diagnosed
with SSc (according to the ACR diagnostic criteria, 2013), who were hospitalized
in the cardiorheumatology and rheumatology departments of the 1st clinic of
TMA. The patients’ ages ranged from 18 to 58 years (mean 35.6±0.7 years), and
the duration of the disease ranged from 1 to 552 months (mean 132.9±7.7
months). The control group (n=65) consisted of individuals without signs of
rheumatic, infectious, or exacerbation of chronic inflammatory diseases. At the
time of the study, the number of patients with moderate disease activity was
41.0%, while low and high activity were equally represented at 29.5% each.
Atherosclerotic vascular damage was detected using ultrasonography (US) of
the carotid arteries. The intima-media complex (IMC) thickness of the carotid
arteries (mm) was measured. Atherosclerotic damage was evaluated by the IMC
thickness (0.9 to 1.2 mm) and the presence of atherosclerotic plaques (ASP),
which were defined as a localized increase in IMC thickness > 1.2 mm.
Results.
Ultrasound examination (US) revealed that atherosclerotic damage
to the carotid arteries was observed in 38 out of 88 patients with systemic
sclerosis (SSc), accounting for 43.1% of the total number of patients examined.
This included two types of changes: intima-media complex (IMC) thickening in
17 patients (19.3%) and the presence of atherosclerotic plaques (AP) in 21
patients (23.8%). The mean IMC thickness in SSc patients was 0.77±0.01 mm for
the average thickness and 0.10±0.03 mm for the maximum thickness. In the
control group, these values were 0.70±0.01 mm and 0.83±0.01 mm, respectively
(with statistically significant differences for both parameters: p=0.003 for
average thickness and p=0.001 for maximum thickness). When comparing the
frequency of atherosclerotic changes between SSc patients and the control
group, it was found that AP, as well as the combination of IMC thickening and AP,
occurred significantly more often in SSc patients, indicating an increased risk of
atherosclerosis in this group. The risk of developing atherosclerotic damage to
the carotid arteries in SSc patients was assessed as 1.47, confirming the high risk
of atherosclerosis and vascular complications in patients with systemic sclerosis.
Conclusions.
The study results confirm that patients with SSc experience
accelerated development of atherosclerotic damage to the carotid arteries
compared to the control group. This highlights the need for regular monitoring
of vascular health in SSc patients to ensure timely detection of atherosclerotic
changes. Additionally, the findings emphasize the need for active prevention and
treatment of atherosclerosis in this patient population, as they are at high
cardiovascular risk. It is important to adopt a comprehensive approach to
SCIENCE AND INNOVATION IN THE
EDUCATION SYSTEM
International scientific-online conference
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treatment, including monitoring vascular condition, correcting risk factors, and
providing timely pharmacological therapy. Therefore, implementing measures
for the prevention of cardiovascular diseases in patients with systemic sclerosis,
as well as in other high cardiovascular mortality risk groups, is an essential
component of a strategy aimed at reducing mortality and improving the quality
of life for these patients.
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