Montpellier, France: Primary Sjogren’s syndrome (pSS) patients are at increased risk of cardiovascular (CV) morbidity as compared with the general population, according to a meta-analysis published in the journal Arthritis Care & Research.
Primary Sjogren’s syndrome is a chronic autoimmune disease with a prevalence of 6.8/10000. It is characterized by lymphocytic infiltration of the exocrine glands (mainly salivary and lacrimal) and is responsible for oral and eye dryness and by B-cell hyperactivity. It primarily afflicts women at about age 50.
Patients with immune‐mediated inflammatory diseases such as rheumatoid arthritis or systemic lupus have a well-recognized risk for cardiovascular disease, which is credited largely to systemic inflammation. However, risk estimates for Sjogren’s syndrome have been conflicting. To get a clear picture of the risks involved Jacques Morel, Department of Rheumatology, CHU Montpellier, University of Montpellier, Montpellier, and colleagues conducted this analysis involving more than 65,000 patients to investigate the association between pSS and cardiovascular morbidity and mortality.
The authors identified 14 studies that had sufficient data for a meta-analysis, the studies included mostly women whose mean age was 55 and whose disease duration was 7 years.
- The risk for coronary morbidity among Sjogren’s syndrome patients was more than 30% higher than for the general population, with a relative risk (RR) of 1.34.
- The risk for cerebrovascular morbidity was increased to an even greater extent.
- With pSS versus control populations, the risk was significantly increased for coronary morbidity, cerebrovascular morbidity, heart failure rate, and thromboembolic morbidity, with no statistically significant increased risk of cardiovascular mortality.
- In five studies that included 24,133 patients with Sjogren’s syndrome and 460,266 controls, the number of coronary events were 7,799 and 84,772, respectively.
- In four studies that included 25,242 patients with Sjogren’s syndrome and 570,183 controls, the number of cerebrovascular events were 605 and 11,367, respectively.
- For thromboembolic events, two studies included 16,090 Sjogren’s syndrome patients and 548,218 controls. In these groups, there were 100 and 15,607 events, respectively
- For heart failure, three studies included 5,920 Sjogren’s syndrome patients and 9,911 controls who had 609 and 358 events, respectively, with an odds ratio of 2.54 for the Sjogren’s syndrome patients.
- Cardiovascular mortality, however, did not appear to be elevated. In two studies that included 745 patients, there were 25 cardiac-related deaths.
Possible explanations for the lack of significant risk of cardiovascular mortality were lower rates of smoking and less use of corticosteroids among patients with Sjogren’s syndrome compared with patients with rheumatoid arthritis and systemic lupus erythematosus, conditions in which cardiovascular mortality is clearly elevated.
In the studies that reported on cardiovascular risk factors, patients with Sjogren’s syndrome had high rates of hyperlipidemia and hypertension, which also could contribute to atherosclerosis.
The presence of circulating autoantibodies could further raise risks. In particular, anti-SSA/Ro and anti-SSB/La antibodies have often been detected in patients with Sjogren’s syndrome who have cardiovascular comorbidities and systemic involvement.
“Prospective studies are needed to further study the association between cardiovascular events and primary Sjogren’s syndrome,” including the potential contributions of steroids and other medications.
“However, rheumatologists should be aware of this increased risk in order to propose screening for cardiovascular comorbidities and specific preventive interventions for patients with primary Sjogren’s syndrome,” the authors concluded.
For further reference log on to https://doi.org/10.1002/acr.23821