Purpose of reviewSystemic sclerosis (SSc) is a systemic inflammatory,
autoimmune disorder characterized by diffuse fibrosis of the skin and
visceral organ involvement. Endothelial dysfunction and microvascular
injury dominate the pathophysiology and clinical manifestations of the
disease, while the impact of macrovascular atherosclerotic disease on
cardiovascular (CVD) morbidity and mortality is yet to be established.
In this article, we aim to review current knowledge about CVD as well as
cardiac complications in SSc and discuss the potentially implicated
pathogenetic mechanisms.Recent findingsSystemic inflammation has been
identified as an important trigger and contributor for the development
and progression of atherosclerosis, closely associated with high
cardiovascular mortality in patients with autoimmune disorders, such as
rheumatoid arthritis. A close interplay between traditional risk factors
and factors related to the disease, including inflammation, endothelial
injury, and immune-mediated cytotoxicity, sharing common pathogenetic
features with microvasculopathy, may be responsible for large-vessel
involvement and promotion of atherosclerosis in SSc. Cardiac
complications, including heart failure due to impairment of coronary
microcirculation and myocardial fibrosis, are listed among the primary
cause of death in SSc. Evaluation of indirect surrogate markers of CVD,
namely, arterial stiffness, carotid media thickness, and flow-mediated
dilation, in small studies has provided inconsistent results regarding
the association between SSc and atherosclerosis, highlighting the need
for further research on this field. In this article, we aim to review
current knowledge about large-vessel involvement and CVD in SSc and
discuss the potentially implicated pathogenetic mechanisms.SummarySSc
conveys a higher risk for CVD associated with both vascular and fibrotic
complications during the course of the disease. Increasing attention is
given on the use of vasodilators, immunosuppressants, and more recently
antifibrotic drugs that potentially improve myocardial function and
reduce atherosclerotic disease burden