Older Age Associated With Greater Cardiac Involvement in Early Systemic Sclerosis

inflammation CVD_TS_450534929
inflammation CVD_TS_450534929
In patients in the early stages of systemic sclerosis, older patients had more severe disease with greater cardiac involvement.

Study data published in the Scandinavian Journal of Rheumatology suggest an association between older age and greater cardiovascular involvement during the early stages of systemic sclerosis (SSc).

Researchers performed a cross-sectional analysis of the prospective EULAR Scleroderma Trials and Research group database. Patients in the early stages (<3 years duration) of SSc (n=1027) with and without Raynaud’s phenomenon were included in analysis. Researchers captured several SSc-related variables, including anti-Scl-70 antibodies, anticentromere antibodies (ACAs), and organ involvement. The study cohort was 90% Caucasian and 80% women, and analyses were stratified by age and SSc subtype.

The diffuse SSc subtype was associated with younger age; 54% of patients ≤30 years presented with diffuse cutaneous SSc compared with just 40% and 34% of patients aged 31 to 59 years and ≥60 years, respectively (P =.001). Younger patients (≤30 years) also had significantly higher levels of anti-Scl-70 antibodies compared with patients aged 31 to 59 years and ≥60 years (53% vs 35% and 30%, respectively). According to frequency analyses stratified by age groups (≤30 years, 31 to 59 years, and ≥60 years), older age was associated with increased pulmonary systolic pressure (5%, 13%, and 30%, respectively), cardiac conduction blocks (6%, 6%, and 15%), and left ventricular dysfunction (4%, 12%, and 27%). Increasing age also correlated with limited cutaneous SSc involvement (35%, 53%, and 58%), ACA positivity (9%, 27%, and 39%), and diastolic dysfunction (3%, 12%, and 26%).

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Among patients in the very early duration stage (<12 months) of SSc, similar trends were observed. In analyses stratified by SSc subsets, older patients with diffuse cutaneous SSc had higher frequency of diastolic dysfunction (P <.0001) compared with their younger counterparts. Among patients with limited cutaneous SSc, older age was associated with ACA positivity, elevated pulmonary systolic pressure, left ventricular dysfunction (all P <.0001), and cardiac conduction blocks (P =.003).

For patients in the early stages of SSc, older age was associated with elevated cardiac involvement and increased disease severity, whereas younger age correlated with diffuse disease presentation. The data underscore the necessity of targeted intervention strategies for each age and disease subgroup for proper management of SSc.

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Carreira PE, Carmona L, BE Joven, et al. Differences associated with age at onset in early systemic sclerosis patients: a report from the EULAR Scleroderma Trials and Research Group (EUSTAR) database [published online July 24, 2018]. Scand J Rheumatol. doi:10.1080/03009742.2018.1459830