Increased Cardiovascular Risk in Sjögren's Syndrome

Alice Goodman

June 14, 2014

PARIS — Patients with Sjögren's syndrome have a significantly higher risk for heart attack and stroke than people in the general population. And the risk is highest in the first year after diagnosis, according to a new population-based study.

"We believe that the acute inflammatory state in Sjögren's, particularly at the onset of disease, is the main driver for increased risk of heart attack and stroke," said Antonio Avina-Zubieta, MD, a research scientist at the Arthritis Research Centre of Canada and assistant professor at the University of British Columbia in Vancouver, Canada.

"Heart attack and stroke should not be considered comorbidities but direct complications of the disease," he said.

This is the first study to compare the risk for cardiovascular events in patients with Sjögren's syndrome and a matched control group. Because Sjögren's syndrome is relatively rare, there has been little research on these patients.

Dr. Avina-Zubieta presented the results here at the European League Against Rheumatism (EULAR) Congress 2014.

Databases for physician visits and hospital admissions in British Columbia from 1990 to 2010 and for dispensed medications from 1995 to 2010 were used to identify patients with Sjögren's syndrome who were older than 18 years.

Ten age- and sex-matched control participants were selected for each patient with Sjögren's. "Analysis was adjusted for traditional risk factors for cardiovascular disease to isolate the effect of Sjögren's," Dr. Avina-Zubieta reported.

During the 3.1 years of follow-up, the rate of heart attack was higher in the Sjögren's group than in the control group (2.4% vs 1.2%), as was the incidence rate (7.7 vs 3.5 per 1000 patient- years).

The rate of stroke was also higher in the Sjögren's group than in the control group (1.6% vs 1.1%), as was the incidence rate (5.1 vs 3.4 per 1000 patient-years).

On multivariate analysis adjusted for cardiovascular risk factors, the risk for heart attack was 2.36 times higher in the Sjögren's group than in the control group, and the relative risk for stroke was 1.6 times higher.

In the first year after diagnosis, the risk for heart attack was 3.6 times higher in the Sjögren's group than it was in the control group. This trend was not observed for stroke.

In general, patients see their physician when they have symptoms, so the diagnosis is usually made when levels of inflammation are high. This might explain why the risk for heart attack is highest in the first year, said Dr. Avina-Zubieta.

"Our results support the role of inflammation in cardiovascular disease and the need for increased vigilance in all patients with Sjögren's. Rheumatologists and other physicians who treat these patients should be aware of the cardiovascular risk and manage accordingly," Dr. Avina-Zubieta said.

"Sjögren's syndrome is grossly neglected and underrecognized," said EULAR president Gerd Burmester, MD, from the Charité-Universitätsmedizin in Berlin, Germany.

"It can destroy the joints, cause dry eyes, dry mouth, and even affect the genitals. Patients can also have tremendous fatigue," he explained.

Dr. Burmester said that although the disease is considered rare, it is not rare in his clinical practice. "People think only older people are affected, but even young children can develop this disease."

"Rheumatologists should attend to cardiovascular risk in their patients with Sjögren's. We know this about rheumatoid arthritis and lupus, and now we know that patients with Sjögren's are at increased cardiovascular risk," he said.

Dr. Avina-Zubieta has disclosed no relevant financial relationships. Dr. Burmester reports financial relationships with BMS, AbbVie, Pfizer, MedImmune, MSD, Novartis, Roche, UCB, and Lilly.

European League Against Rheumatism (EULAR) Congress 2014: Abstract OP0212. Presented June13, 2014.

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