A qualitative systematic review of the prevalence of coronary artery disease in systemic sclerosis

Abstract

Aims: To review existing literature on the prevalence/incidence of coronary artery disease (CAD), and secondarily highlight risk factors for CAD in systemic sclerosis (SSc).

Methods: A PubMed and Cochrane Central Register of Controlled Trials search of studies (till 30 November 2013) relating to SSc and CAD was performed, retrieving 180 titles.

Inclusion criteria: studies reporting CAD prevalence/incidence in SSc based on autopsy findings, coronary artery calcium scores, coronary angiographic findings and physician/patient-reported CAD.

Exclusion criteria: (i) not written in English; (ii) not concerned with human subjects; (iii) single case reports or review articles; (iv) genetic studies; and 95) other surrogate outcome measures of atherosclerosis. Quality assessment was done using the Newcastle-Ottawa score (range 0-9).

Results: Thirteen studies (Newcastle-Ottawa score 5-8) were selected. Of eight studies with controls, seven reported increased CAD prevalence (10-56%) or incidence (2.3%) compared to controls (prevalence 2-44%; incidence 1.5%). Of five studies without controls, CAD prevalence was 8-32%. Five of six studies reported that traditional cardiovascular risk factors were similar/reduced in SSc compared to controls. SSc was an independent risk factor for CAD, in addition to age (n = 2), hypercholesterolaemia (n = 3), male gender (n = 1), hypertension and diabetes (n = 1). Disease duration, renal involvement and pulmonary arterial hypertension were associated with CAD.

Conclusions: Systemic sclerosis is associated with an increased prevalence/incidence of CAD. SSc is an independent risk factor for CAD. The association of CAD with SSc-related factors requires further research. Meanwhile, patients with SSc should be screened and treated for identified traditional cardiovascular risk factors.

Keywords: atherosclerosis; coronary artery disease; systematic review; systemic sclerosis.