Consideration of Cardiovascular Risk Factors in Management of Patients With Primary Sjögren Syndrome

Extraglandular involvement was associated with higher occurrence of cardiovascular conditions, including arterial hypertension, dyslipidemia, hyperuricemia, and coronary artery disease, among patients with primary Sjögren syndrome, according to study results published in Clinical Rheumatology.

Investigators assessed the prevalence and predictors of cardiovascular risk factors and diseases among patients with primary Sjögren syndrome and aimed to develop a standard procedure for risk evaluation in clinical practice settings.

A retrospective study was conducted including patients diagnosed with primary Sjögren  syndrome according to 2016 American College of Rheumatology/European League Against Rheumatism classification criteria.

The primary endpoint was the prevalence of cardiovascular risk factors and diseases and the association between glandular/extraglandular involvement and autoantibodies with cardiovascular risk. Secondary endpoints included the potential risk factors associated with cardiovascular involvement through variables such as extraglandular involvement, corticosteroid treatment, disease activity measured by European League Sjögren syndrome disease activity index (ESSDAI), inflammatory markers, and serologic markers.

A total of 102 patients were included in the analysis. The majority of patients were women (82%) and mean disease duration was 12.5±6 years.

Thirty-six patients had at least one cardiovascular risk factor. Among these, arterial hypertension was the most common (59%), followed by dyslipidemia (27%), diabetes (15%), obesity (22%), and hyperuricemia (18%).

Among patients with cardiovascular risk factors, 25% had a history of arrhythmia, 10% had conduction defects, 7% had arterial peripheral vascular disease, 10% had venous thrombosis, 24% had coronary artery disease, and 22% had cerebrovascular disease.

Compared with patients in the control group, those with extraglandular involvement had a higher prevalence of arterial hypertension (68% vs 49%; P =.04), dyslipidemia (41% vs 14%; P =.003), hyperuricemia (27% vs 9%; P =.03), coronary artery disease (35% vs 12%; P=.01), and higher low-density lipoprotein values (116±48 vs 99±44; P =.038).

Risk for hyperuricemia (31% vs 8.0%; P =.01), arrhythmia (35% vs 14%; P =.01), coronary artery disease (24% vs 8.0%; P =.02), cerebrovascular disease (39% vs 10%; P =.02), and venous thrombosis (18% vs 2%; P =.03) were found to be significantly higher among patients with Ro/SSA and La/SSB autoantibodies vs patients who were seronegative.

The analysis further revealed that several factors increased the likelihood of experiencing cardiovascular risk factors, including extraglandular involvement (P =.02), treatment with corticosteroids (P =.02), ESSDAI score greater than 13 (P =.02), low levels of C3 (P =.03), and high levels of gamma globulins (P =.02).

This analysis was limited by the small number of comorbidities assessed. Additionally, their presence was confirmed via medical history, potentially excluding some data and underestimating the prevalence of certain cardiovascular risk factors. Finally, patients with severe extraglandular involvement received glucocorticoids, which can contribute to the development of comorbidities.

The study authors concluded, “Collaboration with specific preventive units and with primary care is also encouraged to initiate appropriate therapy to prevent or reduce sequelae from cardiovascular risk factors. As with other rheumatological diseases, such

as [rheumatoid arthritis] and [systemic lupus erythematosus], assessing and managing traditional and modifiable cardiovascular risk factors are essential to prevent cardiovascular events.”