Study links serious cardiovascular events to higher death risk in Sjögren’s
About 5 out of every 100 patients with disease may experience such issues
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About five out of every 100 people with Sjögren’s disease may experience serious cardiovascular events over nearly 10 years of follow-up, and these events are linked to a higher risk of death of any cause, a study in Spain shows.
In addition to traditional cardiovascular risk factors, disease-specific factors such as the presence of cryoglobulins — abnormal antibodies that clump together at low temperatures — and treatment with standard glucocorticoids were associated with a higher chance of major cardiovascular events in Sjögren’s patients.
“These findings support integration of cardiovascular risk assessment into routine clinical care for patients with SjD [Sjögren’s disease] and support the development of tailored predictive tools incorporating immunoinflammatory and treatment-related drivers of cardiovascular disease,” researchers wrote.
The study, “Major adverse cardiovascular events in Sjögren’s disease: incidence, associated factors, and impact on mortality in a prospective multicenter cohort,” was published in Rheumatology International.
Researchers explore long-term risk of cardiovascular complications
Sjögren’s is caused by self-reactive antibodies that primarily attack the glands that produce tears and saliva, leading to symptoms such as dry eyes and mouth. However, the disease may also affect other parts of the body, including the lungs, nervous system, and blood vessels.
While previous studies have reported an increased risk of cardiovascular problems, such as heart attack and stroke, among people with Sjögren’s, few have “quantified MACE [major adverse cardiovascular event] using standardized definitions or assessed their long-term prognostic impact,” the researchers wrote.
To better understand the long-term risk of cardiovascular complications and their association with death of any cause, known as all-cause mortality, a team of researchers in Spain followed 314 people with Sjögren’s (median age 58.7 years; 94.6% women) for a median of 9.5 years.
All patients were enrolled in a patient registry spanning 33 hospitals across Spain. They had been living with the disease for a median of 6.8 years at the start of the study.
MACE group had significantly higher rates of high blood pressure
During follow-up, 17 patients (5.41%) experienced at least one major adverse cardiovascular event (MACE), including non-fatal stroke (2.23%), non-fatal heart attack (1.59%), and cardiovascular-related death (1.59%).
Twelve other cardiovascular complications (3.82%) were also recorded, including inflammation of the membrane surrounding the heart and issues with the electrical system that controls the heart’s rate and rhythm.
Patients who experienced a major adverse cardiovascular event were significantly older at study’s start (67.9 vs. 58.3 years) and had lived with Sjögren’s for longer (9.9 vs. 6.4 years) relative to those without such events.
Collectively, these findings support the concept that cardiovascular risk in [Sjögren’s disease] is shaped not only by traditional factors but also by immune-mediated and treatment-related mechanisms.
The MACE group also had significantly higher rates of high blood pressure (58.8% vs. 24.6%), a traditional cardiovascular risk factor, compared with the non-MACE group.
“No significant differences were found for other conventional cardiovascular risk factors,” the team wrote.
Patients who experienced a MACE were significantly more likely to test positive for cryoglobulins than those without such events (11.8% vs. 2.7%) and to be on glucocorticoids, a class of anti-inflammatory medications (75% vs. 44.4%). Cryoglobulins can block small blood vessels, trigger inflammation and immune responses, and damage organs.
In contrast, this group had significantly lower rates of elevated antibody levels in the blood (29.4% vs. 54.5%).
Statistical analyses accounting for multiple factors showed that older age, the presence of cryoglobulins, and glucocorticoid use were each significantly associated with higher odds of major adverse cardiovascular events. In contrast, elevated blood antibody levels were significantly linked to lower odds.
“Collectively, these findings support the concept that cardiovascular risk in [Sjögren’s disease] is shaped not only by traditional factors but also by immune-mediated and treatment-related mechanisms,” the researchers wrote.
Smoking less common among Sjögren’s patients
Researchers also compared the number of cardiovascular events during the study with the number predicted by SCORE2, a tool to estimate a person’s 10-year risk of cardiovascular disease based on common risk factors such as age, blood pressure, cholesterol (a fatty molecule), smoking status, and diabetes.
Among the 130 patients with complete data, SCORE2 estimated a 10-year cardiovascular risk of 4.4%, corresponding to 5.7 expected events over the study period, and six major adverse cardiovascular events were effectively recorded during follow-up.
During follow-up, 42 patients died, including five (11.9%) from cardiovascular causes. People who experienced a major cardiovascular event during the study were significantly more likely, by about 3.5 times, to die from any cause than those who did not experience a MACE.
Compared with the general Spanish population, people with Sjögren’s were more likely to have several traditional cardiovascular risk factors, such as high blood pressure (26.4% vs. 19.1%) and high blood levels of cholesterol (46% vs. 15.3%). By contrast, smoking was less common among people with Sjögren’s (8.3% vs. 19.8%).
“This pattern aligns with previous reports of adverse [fatty molecule] profiles … in SjD, which promote … dysfunction [of cells lining blood vessels] and [blood vessel] inflammation,” the team wrote. “Lower smoking rates, consistently observed in SjD, likely reflect symptom-related behavioral adaptations.”
Overall, the findings “do not suggest a clear population-level excess of cardiovascular mortality in SjD,” but rather “indicate that patients with prior or [new] MACE had higher all-cause mortality,” the researchers concluded.
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