Cardiovascular risk factors in primary Sjögren's syndrome: a case-control study in 624 patients

Abstract

We evaluated the prevalence and clinical significance of cardiovascular risk factors in a large series of patients with primary Sjögren's syndrome (SS), focusing on the possible association with clinical and immunological SS features, the therapies administered, and the impact on cardiovascular disease. The study cohort included 312 patients fulfilling the 2002 classification criteria for primary SS, consecutively evaluated and followed in our department between 1984 and 2009. The control group consisted of 312 age- and sex-matched patients without systemic autoimmune diseases followed during the study period in a primary care centre. In comparison with the age- and sex-matched control group, patients with primary SS showed a higher frequency of diabetes mellitus (27% versus 13%, p < 0.001) and hypertriglyceridaemia (22% versus 15%, p = 0.023), and a lower frequency of hypertension (30% versus 46%, p < 0.001) and smoking (19% versus 31%, p < 0.001). The adjusted, multivariate analysis showed that SS patients with at least three cardiovascular risk factors had a higher mean age at SS diagnosis (p < 0.001), a higher frequency of liver involvement (p = 0.01) and central nervous system involvement (p = 0.001), higher mean levels of C-reactive protein (CRP, p = 0.001), a lower percentage of circulating gamma globulins (p = 0.001), and had received corticosteroids more frequently (p = 0.003) in comparison with patients without cardiovascular risk factors. Patients who had received corticosteroids showed a higher frequency of hypertension (37% versus 25%, p = 0.032), diabetes mellitus (37% versus 21%, p = 0.002), and hypertriglyceridaemia (33% versus 15%, p < 0.001). Patients with primary SS showed a twofold higher prevalence of diabetes mellitus and a 1.5-fold higher prevalence of hypertriglyceridaemia in comparison with primary care patients. Corticosteroid use was closely associated with cardiovascular risk factors. These results suggest that cardiovascular risk factors should be taken into account in the management of patients with primary SS and show the importance of recognizing and controlling both traditional and SS-related modifiable risk factors.

Prevalence of and Factors Associated With Increased Arterial Stiffness in Patients With Primary Sjögren's Syndrome

“…Supporting this observation, in a cohort of young women with primary SS who were not receiving corticosteroids or immunosuppressive agents, the frequency of increased CIMT defined as a mean CIMT Ͼ0.90 mm was approximately half (9). In contrast, Perez-de-Lis et al found that primary SS patients with Ն3 CV risk factors took corticosteroids more frequently than those without CV risk factors (5).…”

“…Primary SS shares several pathophysiologic characteristics with SLE, such as systemic inflammation and immunologic disturbances that indicate the presence of circulating autoantibodies (e.g., rheumatoid factor [RF] and antinuclear and anti-SSA/SSB antibodies). In addition, an increase in traditional CV risk factors such as hypertension and dyslipidemia has also been observed in primary SS (5,6). In this setting, it is conceivable that patients with primary SS may also have an increased CV risk.…”

Subclinical Carotid Atherosclerosis in Elderly Patients with Primary Sjögren Syndrome: A Duplex Doppler Sonographic Study

“…The results are summarized in Tables II, III and IV. DISCUSSION Convincing evidence demonstrates that connective tissue diseases· such as rheumatoid arthritis, systemic lupus: erythematosus, antiphospholipid syndrome and others, are associated with increased prevalence of atherosclerosis, cardiovascular risk and increased mortality (1-9, 18, 19); chronic inflammation, immunologic alterations and the need for immunosuppressive treatment (steroids) greatly favor the development of early atherosclerosis (20). On the other hand, diabetes mellitus and hypertriglyceridaemia have been detected to be the most important cardiovascular risk factors in pSS, especially when the patients have been massively treated with corticosteroids (21). However, pSS rarely shows a significant systemic chronic inflammation and it does not often need treatments that may be vessel-injuring (22).…”

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

“…Disease duration and several clinical and immunological features, including joint involvement, parotid swelling, Raynaud's phenomenon, leucopenia and anti-SSA/Ro and anti-SSB/La antibodies, seem to contribute to subclinical ATS damage in these patients [12][13][14][15][16]. By contrast, the prevalence and the role of traditional CV disease risk factors in the induction of precocious ATS have not been extensively investigated [17,18]. In addition, the risk of clinically manifested major CV events and long-term CV outcome in patients with pSS remain unclear.…”