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At study enrolment, functional and laboratory parameters of endothelial dysfunction were assessed. Microvascular events, defined as the development of DU and PH, macrovascular events, defined as newly symptomatic atherosclerotic cardiovascular diseases, and clinical events, defined as additional interstitial lung disease (ILD), renal crisis and esophageal dysfunction, were recorded annually.\u00a033 patients (86.8%) completed all follow-up study visits. During the follow-up period, DU, PH, carotid and vertebral artery disease and ILD occurred in eight (24.2%), one (3.0%), one (3.0%) and two patients (6.1%), respectively, without recorded renal crisis and esophageal dysfunction. Number of pathologic FMD, NMD and\/or PWV values was significantly associated with the development of clinical events (<jats:italic>p<\/jats:italic>\u2009=\u20090.035), but was not a significant predictor for microvascular events. Number of pathologic FMD, NMD and\/or PWV values was a significant predictor for disease activity assessed by EUSTAR index\u2009\u2265\u20092.5 at last study visit (OR 5.47 [95% CI 1.01\u201329.03], <jats:italic>p<\/jats:italic>\u2009=\u20090.049).\u00a0Distinct endothelial dysfunction may promote the development of disease complications and disease activity in patients with lcSSc.<\/jats:p>","DOI":"10.1007\/s00296-025-05919-y","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T07:17:12Z","timestamp":1751959032000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Endothelial function and vascular events in patients with limited cutaneous systemic sclerosis (EFVELSS): a prospective observational 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