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Cardiovascular disease risk burden in primary Sjögren's syndrome: results of a population-based multicentre cohort
E Bartoloni1, C Baldini2, G Schillaci3
1Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
Insights
Primary Sjögren's syndrome (pSS) patients face a higher risk of cardiovascular events like stroke and heart attack. Disease factors, not just traditional risks, contribute to this increased cardiovascular disease risk in pSS.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Systemic autoimmune diseases increase cardiovascular disease (CVD) risk.
- Limited data exists on CVD event risk in primary Sjögren's syndrome (pSS).
Purpose of the Study:
- To investigate the risk of overt cardiovascular events in patients with primary Sjögren's syndrome (pSS).
- To compare CVD risk factors and events in pSS patients versus age-matched healthy women.
Main Methods:
- Retrospective analysis of 1343 pSS patients.
- Recorded disease characteristics, traditional CVD risk factors, and CV events.
- Compared risk factors and major CV events in 788 female pSS patients (35-74 years) against 4774 controls.
Main Results:
- pSS patients had higher prevalence of hypertension and hypercholesterolaemia.
- Cerebrovascular events and myocardial infarction were more frequent in pSS patients.
- Central nervous system involvement and immunosuppressive therapy use increased CV event risk.
Conclusions:
- Primary Sjögren's syndrome is linked to elevated risks of cerebrovascular events and myocardial infarction.
- Disease-specific clinical and immunological markers may influence cardiovascular event development in pSS.
Objective:
Systemic autoimmune diseases, in particular systemic lupus erythematosus and rheumatoid arthritis, are characterized by a high risk of premature cardiovascular (CV) events. Disease-related 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 Sjögren'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.
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