Cardiovascular disease risk prediction in scleroderma

Çelikkol, Aliye; Mercan, Rıdvan; Güzel, Savaş; Yılmaz, Ahsen

doi:10.1590/1806-9282.20220936

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (2) • 2023 • https://doi.org/10.1590/1806-9282.20220936 copy

Cardiovascular disease risk prediction in scleroderma

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Cardiovascular disease risk prediction in scleroderma is important. In this study of scleroderma patients, the aim was to investigate the relationship between cardiac myosin-binding protein-C, sensitive troponin T, and trimethylamine N-oxide and cardiovascular disease risk with the Systematic COronary Risk Evaluation 2 model of the European Society of Cardiology.

METHODS:

Systematic COronary Risk Evaluation 2 risk groups of 38 healthy controls and 52 women with scleroderma were evaluated. Cardiac myosin-binding protein-C, sensitive troponin T, and trimethylamine N-oxide levels were analyzed with commercial ELISA kits.

RESULTS:

In scleroderma patients, cardiac myosin-binding protein-C and trimethylamine N-oxide levels were higher than healthy controls but sensitive troponin T was not (p<0.001, p<0.001, and p=0.274, respectively). Out of 52 patients, 36 (69.2%) were at low risk, and the other 16 (30.8%) patients were at high-moderate risk with the Systematic COronary Risk Evaluation 2 model. At the optimal cutoff values, trimethylamine N-oxide could discriminate high-moderate risk with sensitivity 76%, specificity 86% and cardiac myosin-binding protein-C with sensitivity 75%, specificity 83%. Patients with high trimethylamine N-oxide levels (≥10.28 ng/mL) could predict high-moderate- Systematic COronary Risk Evaluation 2 risk 15 times higher than those with low trimethylamine N-oxide (<10.28 ng/mL) levels (odds ratio [OR]: 15.00, 95%CI 3.585–62.765, p<0.001). Similarly, high cardiac myosin-binding protein-C (≥8.29 ng/mL) levels could predict significantly higher Systematic COronary Risk Evaluation 2 risk than low cardiac myosin-binding protein-C (<8.29 ng/mL) levels (OR: 11.00, 95%CI 2.786–43.430).

CONCLUSION:

Noninvasive cardiovascular disease risk prediction indicators in scleroderma, cardiac myosin-binding protein-C, and trimethylamine N-oxide could be recommended to distinguish between high-moderate risk and low risk with the Systematic COronary Risk Evaluation 2 model.

KEYWORDS:
Heart disease risk factors; Myosin-binding protein C; Troponin T; Trimethyloxamine; Scleroderma, systemic

			Healthy group (n=38)	SSc patients (n=52)
			Mean±SD/(min-max)	Mean±SD/(min-max)/n (%)
Demographic characteristics
	Age (year)		51.263±8.83	54.35±8.28
	BMI (kg/m²)		28.78±2.21	29.19±3.45
Laboratory characteristics
	Glucose (mg/dl)		93.21±6.52	103.87±17.08^* ***** p<0.001
	Creatinine (mg/dl)		0.65±0.09	0.67±0.18
	CRP (mg/l)		1.72 (0.2–5.0)	2.24 (0.15–5.93)
	TChol (mg/dl)		156.02±15.22	236.23±47.03^* ***** p<0.001
	TG (mg/dl)		101.74±29.07	186.86±58.94^* ***** p<0.001
	HDL-C (mg/dl)		53.39±11.04	46.83±11.39^ p<0.01
	LDL-C (mg/dl)		80.70±13.40	148.57±43.17^* ***** p<0.001
	Non-HDL-C (mmol/l)		3.35±0.73	4.96±1.12^* ***** p<0.001
	SCORE2		3.58 (1.0–10.0)	9.5 (1.0–29.0)^* ***** p<0.001
	cMBPC (ng/mL)		4.92±1.18	8.03±3.29^* ***** p<0.001
		sTrT (ng/L)	55.94±20.41	60.13±15.66
		TMAO (ng/mL)	6.90±1.23	10.45±3.01^* ***** p<0.001
Clinical characteristics
	Current smoking			22 (42.30)
	Disease duration
			1–5 years	14 (27)
			6–10 years	28 (54)
			>10 years	10 (19)
	Diffuse SSc (positive)			11 (21.15)
	Localized SSc (positive)			29 (55.77)
	Digital ulcer (positive)			11 (21.15)
	Digital gangrene (positive)			2 (3.85)
	Telangiectasia (positive)			12 (23.08)
	Proximal muscle weakness (positive)			14 (26.92)
	Gastrointestinal symptoms (positive)			22 (42.31)
	Pulmonary symptoms (positive)			4 (7.69)
	Cardiovascular symptoms (hypertension)			23 (44.23)
Antibody characteristics
	Anti-cyclic citrullinated peptide (positive)			4 (7.69)
	Rheumatoid factor (positive)			8 (15.38)
	ANA cytoplasmic speckled (positive)			10 (19.23)
	ANA anti-centromere (positive)			16 (30.77)
	ANA SCL-70 (positive)			14 (26.92)
	ENA anti-Ro (SSA) (positive)			10 (19.23)
	ENA anti-centromere B (positive)			16 (30.77)
	ENA anti-SCL-70 (positive)			17 (32.69)
	ENA Ro-52 recombinant (positive)			11 (21.15)

Variable	Category	Univariate analysis		Multivariate analysis
Variable	Category	OR (95%CI)	p-value	OR (95%CI)	p-value
TMAO	<10.28/≥10.28	15.000 (3.585–62.765)	<0.001	9.405 (2.020–43.791)	0.004
cMBPC	8.29/≥8.29	11.000 (2.786–43.430)	0.001	6.236 (1.329–29.256)	0.020
sTrT	52.24/≥52.24	1.437 (0.439–4.699)	0.549
CRP	Continuous	0.989 (0.849–1.152)	0.883
LDL-C	Continuous	1.003 (0.989–1.017)	0.656
ALB	Continuous	1.965 (0.423–9.140)	0.389
BMI	Continuous	1.301 (1.033–1.640)	0.025
C3	Continuous	0.695 (0.068–7.098)	0.759
C4	Continuous	0.004 (<0.001–6.824)	0.147
IgM	Continuous	0.754 (0.384–1.484)	0.414
IgG	Continuous	0.938 (0.779–1.131)	0.505
IgA	Continuous	0.782 (0.433–1.412)	0.414

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[1] *Corresponding author: acelikkol@nku.edu.tr