CARDIOVASCULAR AND CEREBROVASCULAR RISK IN PATIENTS WITH SMALL VESSEL VASCULITIDES: A COMPARATIVE ANALYSIS BETWEEN AORTIC STIFFNESS, CAROTID SONOGRAPHY AND SCORE
Authors: K. Triantafyllias et al.
Cardiovascular (CV) and cerebrovascular (CVB) risk in small vessel vasculitides is rarely assessed. There exists no data about traditional risk scores, such as the Systematic COronary Risk Evaluation (SCORE) and the EULAR modified version (mSCORE).
Three German centres investigated the performance of the SCORE, the mSCORE and, in addition, the gold standard marker of aortic stiffness, the carotid-femoral pulse wave velocity (cfPWV). Furthermore, they performed sonography of the carotid arteries in a subset of patients, evaluating intima-media-thickness (IMT), the presence of plaque and duplex-sonographic indices of CBV risk, such as the resistance- (RI) and pulsatility-index (PI). 46 patients with small vessel vasculitides (33 GPA, 6 eGPA, 4 MPA, 1 cryoglobulinemic vasculitis, 2 urticaria vasculitis) and 105 healthy controls were analyzed. The cfPWV was significantly higher in the patient group compared to the control group. The carotid sonography revealed higher CVB surrogates in the patient subgroup, compared to controls. According to SCORE and mSCORE, 0.9% and 15.8% of the patients had high CV risk, respectively. However, cfPWV revealed an increased CV risk in 28.2% of the patients. Moreover, carotid sonography showed signs of subclinical carotid arteriosclerosis in 50% (plaques) and 71.7% (IMT >0.9 mm) of the patients, respectively.
Although the study has not prospectively assessed the prediction of CV and/or CVB events, the data strongly suggest measuring the cfPWV and performing carotid sonography and not relying on SCORE or mSCORE. It argues for dissemination of knowledge in ultrasound technology about large arterial blood vessels (in addition to the already established ultrasound technology to diagnose Giant Cell Arteritis).