SUBCLINICAL ATHEROSCLEROSIS AND CARDIOVASCULAR RISK IN MYOSITIS PATIENTS AND HEALTHY CONTROLS: PRELIMINARY DATA FROM A SINGLE-CENTER CROSS-SECTIONAL STUDY

BackgroundIdiopathic inflammatory myopathies (IIM) are associated with systemic inflammation, limited mobility, and glucocorticoid (GC) therapy, which can negatively impact metabolic disorders, atherogenesis, and increase the cardiovascular (CV) risk.ObjectivesThis study aimed to evaluate CV risk in IIM patients compared to healthy controls (HC) and explore its associations with disease-specific features.Methods39 patients with IIM (32 females; mean age 56; mean disease duration 4.8 years; dermatomyositis 16, polymyositis 7, immune-mediated necrotizing myopathy 8, antisynthetase syndrome 8) and 39 age-/sex-matched HC (32 females, mean age 56) were included. Subjects with a history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events) were excluded in both groups. Disease activity, damage, and muscle involvement (Manual Muscle Test (MMT)-8, Myositis Intention to Treat Activity Index (MITAX), Myositis Damage Index (MDI)) were assessed. Comorbidities and current treatment were recorded. All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (densitometry: iDXA Lunar, bioelectric impedance: BIA2000-M). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE and SCORE2, charts for the European population; modified mSCORE according to the 2015 EULAR recommendation for inflammatory arthritis - only in IIM patients).ResultsIn IIM, disease activity and damage were predominantly mild (MITAX 0.13, MDI 0.05). Compared to HC, there was no significant difference in the prevalence of traditional risk factors. Only PWV was significantly increased in IIM compared to HC (p=0.015). No other significant difference was observed between the IIM and HC regarding the CV examinations (CIMT, ABI, carotid plaques) and calculated SCORE and SCORE2 (p>0.05 for all). In IIM, age and mean arterial pressure were the most significant parameters that correlated positively with SCORE, SCORE2, and mSCORE; arterial hypertension was significantly associated with a higher SCORE, carotid plaque count/thickness, and PWV. Lipid profile parameters, body composition, and disease activity were significantly associated with CIMT and carotid plaques (p<0.05 for all). Antihypertensive treatment was associated with an increase in carotid plaque count (p=0.020), higher (favorable) ABI (p=0.004), while hypolipidemic treatment was associated with an increase in carotid plaque count/thickness (p=0.009, p=0.008). Diabetes was associated with lower (worse) ABI values (p=0.034), prediabetes with a higher carotid plaque count (p=0.036) and thickness (p=0.011), and a worse ultrasound examination related CV risk (p=0.006). Anti-Jo-1 positivity was associated with a lower (better) CIMT and lower SCORE (p<0.05 for all). There were no significant associations of CV risk with clinical manifestations, immunosuppressive treatment, and GC cumulative dose. However, exposure time to GC therapy was significantly associated with the carotid plaques count (p<0.001) and the carotid plaque thickness (p=0.003). In multivariate analysis, the age of the patients was the most significant factor affecting most of the parameters analyzed (SCORE and its modifications, PVW, CIMT, and the total count of carotid plaques). Other significant predictors were total cholesterol and atherogenic index of plasma (for ABI), mean arterial pressure (for PWV), and disease duration (for the total count of carotid plaques).ConclusionNo significant differences in CV risk factors between IIM patients and HC were observed.In IIM, CV risk was associated with age, disease duration, duration of glucocorticoid therapy, lipid profile, and body composition, but not with clinical manifestations and disease activity.AcknowledgementsSupported by AZV NV18-01-00161A, MHCR-00023728, SVV-260523. GAUK 1578119Disclosure of InterestsNone declared