Atherosclerosis, Cardiovascular Disease More Common in Patients with Primary Sjögren’s Syndrome

Patients with primary Sjögren’s syndrome (pSS) are more likely to be diagnosed with hypertension than the general population. In addition, one-third of patients with pSS have high cholesterol. Despite the presence of these risk factors for cardiovascular (CV) disease, few studies have investigated the prevalence of major CV events in patients with pSS.

Elena Bartoloni, MD, a researcher at the University of Perugia in Italy and colleagues recently published the results of their retrospective analysis of patients with pSS in the Journal of Internal Medicine.¹ Theirs is the first cross-sectional study to investigate the prevalence of CV disease risk factors in a large cohort of patients with pSS (1,284 female and 59 male) compared with age-matched healthy women (n = 4,774). The mean disease duration from diagnosis in the cohort was 5 ± 6 years. Most patients (n = 794) had a documented minor salivary gland biopsy. Xerophthalmia was the most commonly reported symptom of pSS, followed by xerostomia.

The investigators demonstrated that older age and longer disease duration were associated with an increased risk of total CV events, such as cerebrovascular events and myocardial infarction. They found that 5% of patients reported at least one clinically overt CV disease.

Patients in the pSS cohort smoked less than the general population and had a lower prevalence of obesity and diabetes than the control group. The pSS cohort had a higher prevalence, however, of hypertension and hypercholesterolemia.

Patients with pSS experienced more CV events with lung and central nervous system (CNS) involvement than did the general population. CNS involvement and use of immunosuppressive therapy were both associated with a higher risk of CV events in patients with pSS. Circulating anti-SSA/Ro and anti-SSB/La antibodies were more common in patients without any CV disease risk factors.

“Although these findings seem to support a close interaction between some traditional CV disease risk factors and disease-specific features of pSS, we found that patients without overt evidence of traditional risk factors indeed presented circulating anti-SSA/SSB antibodies, leucopenia, hypergammaglobulinaemia and hypocomplementaemia more frequently than subjects with one or more CV disease risk factors,” wrote the authors in the discussion. “These findings, in line with the results of previous studies, appear to further support the independent role of disease-related features in favouring ATS [atherosclerosis] in pSS. This is consistent with the evidence that macrovascular impairment of endothelium-independent function and intima–media layer thickening in pSS are associated with leucopenia and circulating anti-SSA/SSB antibodies.”

Thus, the investigators suggest that the CV events may be related to disease-associated clinical and immunological markers. Specifically, the investigators found that the patients with leucopenia and pSS had a sixfold increased risk of developing angina than did patients with pSS and a normal white cell count.

The study adds to the growing body of literature demonstrating increased morbidity and premature mortality from CV disease in patients with systemic autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. (posted 3/6/15)

Lara C. Pullen, PhD, is a medical writer based in the Chicago area.

Reference

1. Bartoloni E, Baldini C, Schillaci G, et al. Cardiovascular disease risk burden in primary Sjögren’s syndrome: Results of a population-based multicentre cohort study. J Intern Med. 2015 Jan 13. doi: 10.1111/joim.12346. [Epub ahead of print]