Cardiovascular disease risk burden in primary Sjögren's syndrome: results of a population‐based multicentre cohort study

Abstract

Abstract. Bartoloni E, Baldini C, Schillaci G, Quartuccio L, Priori R, Carubbi F, Bini V, Alunno A, Bombardieri S, De Vita S, Valesini G, Giacomelli R, Gerli R (University of Perugia, Perugia; University of Pisa, Pisa; Terni University Hospital, Terni; University of Udine, Udine; Sapienza University of Rome, Rome; University of L'Aquila, L'Aquila; and University of Perugia, Perugia; Italy). Cardiovascular disease risk burden in primary Sj€ ogren's syndrome: results of a population-based multicentre cohort study. J Intern Med 2015; 278: 185-192.Objective. Systemic autoimmune diseases, in particular systemic lupus erythematosus and rheumatoid arthritis, are characterized by a high risk of premature cardiovascular (CV) events. Diseaserelated characteristics and traditional CV disease risk factors may contribute to atherosclerotic damage. However, there are limited data on the risk of overt CV events in primary Sj€ ogren's syndrome (pSS).Methods. We retrospectively analysed a cohort of patients with 1343 pSS. Disease-related clinical and laboratory data, traditional CV disease risk factors and overt CV events were recorded. Prevalence of traditional CV disease risk factors and of major CV events was compared between a subgroup of 788 female patients with pSS aged from 35 to 74 years and 4774 age-matched healthy women.Results. Hypertension and hypercholesterolaemia were more prevalent, whereas smoking, obesity and diabetes mellitus were less prevalent, in women with pSS than in control subjects. Cerebrovascular events (2.5% vs. 1.4%, P = 0.005) and myocardial infarction (MI) (1.0% vs. 0.4%, P = 0.002) were more common in patients with pSS. In the whole population, central nervous system involvement (odds ratio (OR) 5.6, 95% confidence interval (CI) 1.35-23.7, P = 0.02) and use of immunosuppressive therapy (OR 1.9, 95% CI 1.04-3.70, P = 0.04) were associated with a higher risk of CV events. Patients with leucopenia had a higher risk of angina (P = 0.01).Conclusions. pSS is associated with an increased risk of cerebrovascular events and MI. Disease-related clinical and immunological markers may have a role in promoting CV events.

The Potential Role for Early Biomarker Testing as Part of a Modern, Multidisciplinary Approach to Sjögren’s Syndrome Diagnosis

“…Data from the Sjögren's International Collaborative Clinical Alliance (SICCA) registry suggest that primary SS is characterized by immunologic and hematologic abnormalities that may affect multiple organ systems [14]. Patients with SS have an increased risk of cerebrovascular events and myocardial infarction [15], and are more than twice as likely as age-and sex-matched controls to have hypertension and hypertriglyceridemia. Other systemic developments include arthritis (often misdiagnosed as RA), interstitial cystitis, neuropathy, and vasculopathies, including anti-phospholipid antibody syndrome.…”

“…Early diagnosis and treatment of SS can be an 15,26,31,33,34]. Delayed diagnosis can also lead to psychological distress associated with unexplained symptoms [26].…”

Risk of Chronic Obstructive Pulmonary Disease in Female Adults With Primary Sjögren Syndrome

“…26 In addition, most studies reported no significant difference in smoking between pSS patients and controls 27–29 or even significantly fewer smokers in SS patient groups. 30,31 Therefore, patients with SS do not necessarily have a significantly higher smoking rate than those without SS.…”

The clinical spectrum of primary Sjögren’s syndrome: beyond exocrine glands

“…Furthermore, advanced age, higher focus score on minor salivary gland biopsy and reduced salivary flow rates, the presence of Raynaud's syndrome and reduced lymphocyte numbers were predictors of plaque formation (50). Two recent large epidemiological studies attempted to characterize the prevalence of traditional CV risk factors and CV events in pSS patients (51,52). Hypertension was the most prevalent CV disease risk factor, followed by hypercholesterolaemia, and hypertriglyceridemia.…”