Men with Sjögren’s may be at higher pulmonary hypertension risk
Need shown for specific approaches in assessing, managing heart involvement
Men with Sjögren’s disease show more early signs of lung and heart dysfunction than women and may be at an increased risk of developing pulmonary hypertension, a cardiovascular complication of Sjögren’s, a study reports.
“As male patients demonstrated a greater predisposition to developing [pulmonary hypertension] … regular echocardiographic monitoring is recommended for male [Sjögren’s disease] patients, particularly those exhibiting early structural or functional cardiac changes,” the researchers wrote. The study, “Pulmonary hypertension in patients with Sjögren’s syndrome: Gender differences in cardiovascular risk factors and instrumental data,” was published in the International Journal of Cardiology.
In Sjögren’s disease, the immune system mistakenly attacks the body’s own cells, primarily those in the glands that produce tears and saliva. While the main symptoms are dry eyes and dry mouth, people with Sjögren’s may also be at increased risk for lung and heart diseases. One such disease is pulmonary hypertension, which is marked by abnormally high blood pressure in the pulmonary arteries, the blood vessels that carry blood from the heart to the lungs.
Differences between male, female Sjögren’s patients
The true prevalence of pulmonary hypertension among people with Sjögren’s remains unclear, however, leading a team of scientists in Italy to examine data from 56 women and seven men with Sjögren’s who were a mean age of 69. All the participants completed a battery of tests to help assess the structure and function of their heart, along with lung function.
One patient was diagnosed with pulmonary hypertension. The prevalence of the disease in this study (1.6%) was lower than that seen previously in people with Sjögren’s, “likely due to differences in diagnostic criteria and study methodologies,” according to the researchers, who also investigated sex differences in factors related to Sjögren’s and its potential complications, including pulmonary hypertension.
In lung function tests, men scored significantly lower on a few key metrics than women. Men also forcefully expelled less air than women, with more air remaining in their lungs after forcefully breathing out.
The prevalence of pulmonary fibrosis, a lung disease marked by the buildup of scar tissue in the lungs, was also higher in men, and while this wasn’t statistically significant, it may have contributed “to the observed differences in pulmonary function between sexes,” the researchers wrote.
In the male patients, echocardiography tests — ultrasounds that can help visualize the heart and blood vessels — also revealed early changes in blood flow that could be linked to an increased risk of cardiovascular disease.
Blood flow velocity from the right lower chamber of the heart to the pulmonary artery, which takes oxygen-poor blood from the heart to the lungs, was high in men, “suggesting a possible early increase in pulmonary pressures,” according to researchers. The left lower chamber of the heart, which receives oxygen-rich blood and pumps it to the rest of the body, was also enlarged.
Hormonal differences between men and women could explain some of these findings, according to the researchers. “Males appear more vulnerable to structural and functional alterations [in the lungs and heart], likely driven by testosterone-mediated pathways, whereas females may benefit from the cardioprotective effects of estrogen,” they wrote.
The sex differences described in the study highlight “the necessity of adopting gender-specific approaches in the assessment and management of cardiac involvement, ensuring that subtle yet clinically relevant changes are identified and addressed in a timely manner,” they wrote. “Further research is warranted to elucidate the long-term implications of these findings and to refine therapeutic strategies accordingly.”
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