ArticleRheumatology (Oxford, England)2026
High levels of vascular cell adhesion molecule-1 associate with a 'vasculopathic' phenotype in systemic sclerosis with higher mortality.
Article in Rheumatology (Oxford, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo determine disease-specific associations of serum vascular cell adhesion molecule-1 (VCAM-1) and associated mortality in SSc.
methodsParticipants were identified from the Australian Scleroderma Cohort Study. Data were linked with the National Death Index for cause-specific mortality. VCAM-1 was measured using a magnetic Luminex assay. Participant characteristics and information on organ specific manifestations were extracted until February 2024. Participants were stratified into VCAM-1 quartiles.
resultsOf 388 participants, 87.1% were female and 76.8% had limited cutaneous disease. Median age at diagnosis was 45.7 years (interquartile range 36.4-56.7). Participants with upper quartile VCAM-1 (quartile 4; Q4) had increased mortality compared with others [hazard ratio (HR) 2.17, 95% CI 1.54-3.04; P < 0.001]. Despite the significant increased mortality in Q4, there were no statistically significant differences in sex, age, disease duration, disease subtype, autoantibody profile or forced vital capacity across the VCAM-1 quartiles. Q4 were more likely to have pulmonary arterial hypertension (PAH; P = 0.028), SSc-attributable myocardial disease (P = 0.009) and digital ulcers (P = 0.003). In cause-specific mortality analysis, Q4 were more likely to have PAH (HR 3.08, 95% CI 1.68-5.65; P < 0.001), SSc-attributable myocardial disease (HR 2.85, 95% CI 1.51-5.38; P = 0.001) and all-cause cardiovascular disease (HR 2.50, 95% CI 1.60-3.89; P < 0.001) listed as a cause or contributor to death. Q4 VCAM-1 level was not associated with interstitial lung disease presence, severity or cause-specific mortality.
conclusionThe increased mortality in participants with SSc and Q4 VCAM-1 levels is attributable to increased frequency of vascular disease manifestations. Q4 participants do not have a disproportionate frequency of other established risk factors for increased mortality, suggesting an independent role for VCAM-1 in disease pathophysiology.
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