ORIGINAL ARTICLE Established coronary artery disease in systemic sclerosis compared to type 2 diabetic female patients: a cross-sectional study Michele Colaci 1 & Dilia Giuggioli 2 & Amelia Spinella 2 & Caterina Vacchi 2 & Federica Lumetti 2 & Anna Vittoria Mattioli 3 & Francesca Coppi 3 & Vincenzo Aiello 2,4 & Maria Perticone 5 & Lorenzo Malatino 1 & Clodoveo Ferri 2 Received: 7 September 2018 /Revised: 24 December 2018 /Accepted: 1 January 2019 # International League of Associations for Rheumatology (ILAR) 2019 Abstract Introduction Systemic sclerosis (SSc) is an autoimmune disease characterized by endothelial dysfunction, which is also associ- ated with other disorders, such as atherosclerosis. The direct role of SSc in facilitating cardiovascular events should be clarified. We compared the prevalence of established coronary artery disease (CAD) between SSc and type 2 diabetes, a well-known phenotype associated with high cardiovascular risk. Methods In this cross-sectional study, we evaluated a cohort of 290 unselected female SSc patients, in comparison with 265 aged-matched female type 2 diabetics. BEstablished CAD^ was defined as previous myocardial infarction, unstable angina or ischemia documented by ECG and troponin elevation, necessity/previous treatment with coronary angioplasty or stenting. Age subgroups < 45 (Q1), 45–54 (Q2), 55–64 (Q3), 65–74 (Q4), and ≥ 75 (Q5) years were considered for SSc and diabetes. Results CAD prevalence resulted lower in SSc patients than in diabetics (10% (95%CI 6.9–14.1) versus 19.2% (95%CI 14.9– 24.4); p = 0.0023). In Q2 patients, CAD never occurred in SSc (95%CI 0–8.4), but in 9.4% of diabetics (95%CI 3.7–20.7, p = 0.0567); in Q3 subjects, CAD was reported in 5.6% (95%CI 1.8–13.8) of SSc, but in 20% (95%CI 12.4–30.5) of diabetics (p = 0.0127). Instead, for Q4 and particularly Q5 patients, CAD prevalence was comparable in SSc and diabetes. Conclusions The prevalence of established CAD in SSc was lower compared with diabetics. However, in older SSc patients the prevalence of CAD was similar to that observed in diabetics. Keywords Coronary artery disease . Diabetes . Scleroderma . Systemic sclerosis Introduction Systemic sclerosis (SSc) is an autoimmune disease character- ized by an overproduction of collagen by altered fibroblasts and endothelial dysfunction leading to diffuse microangiopa- thy [1]. Clinically, Raynaud’ s phenomenon, digital ulcers, re- nal crisis, and pulmonary arterial hypertension are typical mi- crovascular manifestations of SSc. In addition, a number of recent studies showed a macrovascular involvement in these patients, as revealed by the detection of aortic wall stiffness, vascular intima-media thickening, or impaired flow-mediated dilatation [2–4]. On the other hand, the endothelial dysfunc- tion and diffuse vasculopathy are also known features associ- ated with atherosclerosis, even though plaque formation is prerogative of the latter [5]. In addition, SSc patients with long-lasting disease may develop atherosclerotic alterations more frequently compared to the general population, probably because of the SSc-associated chronic inflammation, a * Michele Colaci michele.colaci@unict.it 1 Department of Clinical and Experimental Medicine, Internal Medicine Unit, Cannizzaro Hospital, University of Catania, Via Messina 829, 95100 Catania, Italy 2 Rheumatology Unit, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy 3 Department of Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy 4 Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy 5 Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy Clinical Rheumatology https://doi.org/10.1007/s10067-019-04427-2