Risk of Heart Failure Increased More Than 40% in Primary Sjögren’s

Study ID'd 5,092 newly diagnosed cases of PSS from 1996 to 2018

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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A woman smiles and feels her heart beating inside her.

People with primary Sjögren’s syndrome (PSS) are at an increased risk of developing heart failure, heart attack, stroke, and other cardiovascular health problems compared with the general population, a new study reports.

“The findings from our analysis could potentially have important clinical implications,” the researchers wrote. “Despite a low absolute risk, the burden of cardiovascular disease in patients with PSS compared with a carefully matched general population is substantial. Given that cardiovascular diseases, particularly [heart failure], are associated with considerable morbidity and mortality, these data highlight the importance of assessment of cardiovascular disease in patients with PSS.”

The study, “Long-term risk of heart failure and other adverse cardiovascular outcomes in primary Sjögren’s syndrome,” was published in the Journal of Internal Medicine.

Heart failure refers to problems with its ability to pump blood to get oxygen and nutrients to all the tissues in the body. Only limited research on how common heart failure or other heart-related health problems are with PSS has been done, leading scientists in Denmark to analyze data from several registries in the country.

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“This nationwide cohort study investigated the association between PSS and incident [heart failure], and other adverse cardiovascular outcomes, in the Danish population,” they wrote. “To the best of our knowledge, our study is the first to investigate the long-term rate of [heart failure] in a large, nationwide cohort of patients with PSS.”

From the databases, the researchers identified 5,092 people newly diagnosed with PSS from 1996 to 2018. They had a median age of 57 and 12.7% were male. Each was matched to four people in the general population with no history of PSS or other autoimmune diseases and were similar in age, sex, and other health conditions.

Over a median follow-up of more than seven years, 4.1% developed heart failure, as compared with 3% in the general population. The risk of heart failure was about 42% higher among PSS patients, with no apparent variations based on age or sex, statistical analyses shown.

“PSS was associated with a higher long-term rate of incident [heart failure] compared with matched individuals from the general population,” the researchers wrote.

For most other heart-related conditions examined, the risk was significantly higher among PSS patients. For example, the risk of heart attack increased by 26%, the risk of stroke by 54%, and the risk of pulmonary hypertension by 90%. The risk of pericarditis — inflammation of the membranes surrounding the heart — increased nearly threefold.

The risk of death from any cause was also significantly higher in PSS patients, by about 13%.

“PSS was associated with an increased rate of a wide range of adverse cardiovascular outcomes,” the researchers wrote, noting the reasons for this higher risk aren’t clear and will need to be investigated. They suggested widespread inflammation in PSS may cause damage to heart and blood vessel tissue, which could set the stage for heart disease.

The researchers also matched each of the 210 PSS patients who developed heart failure with four people in the general population who’d also developed heart failure. Rates of death from any cause were comparable in both groups.

“Among patients with new-onset [heart failure], a history of PSS was not associated with a lower or higher mortality compared with matched individuals without PSS,” the researchers wrote. “This finding is reassuring because other, although more widespread, inflammatory diseases, such as sarcoidosis and [systemic lupus erythematosus], appear to be associated with a worse prognosis in patients with [heart failure].”

The researchers noted their analysis was limited by its reliance on large administrative databases and some important clinical data such as smoking status and body mass index, which are known to affect heart disease risk, were not available.