Background/Purpose: Primary Sjögren’s syndrome (SS) is an autoimmune disease of the exocrine glands with lymphocytic infiltration into lacrimal and salivary glands. Autoimmune diseases increase cardiovascular risk by premature vascular damage. There were observational studies on the risk of ischemic stroke in primary SS patients, but results have been inconclusive. We conducted a meta-analysis to compare incidence of ischemic stroke in SS and normal populations.

Methods: Two investigators searched published articles in EMBASE and PubMed database from 1980 to the end of February 2017 using the terms “Sjögren’s syndrome”, “ischemic stroke”, “stroke”, “cerebrovascular accident”, “cerebrovascular disease”, “cerebrovascular disorder”, “cerebral infarction”, “cerebral ischemia”, “brain infarction” and “brain ischemia”. Manual searching in the conferences abstract database from 2002-2016 was performed. Inclusion criteria were 1) observational studies (cohort, case control, cross sectional studies), 2) studies comparing incidence of ischemic stroke in SS and normal population, 3) studies providing relative risk (RR), odds ratio (OR), or standardized incidence ratio (SIR) with 95% confidence interval (CI). Quality assessment of studies was performed using Newcastle-Ottawa quality assessment scale. Review Manager 5.3 software was used to perform data analysis. Studies were combined by the generic inverse variance method described by Dersimonian and Laird. We used a random-effect model because of the variance in the studies. Cochran’s Q test was used to calculate I² to measure heterogeneity across studies. A funnel plot was used to assess for publication bias.

Results: Five studies (3 cohort studies, 1 case control study, and 1 cross sectional study) were met our criteria with 9,514 patients with primary SS. The pooled risk ratio for ischemic stroke in primary SS patients compared to control populations was 1.21 (95% CI 0.97-1.50), heterogeneity was moderate with I² of 60%, there was no evidence of publication bias from funnel plot.

Conclusion : We found no statistically significant increased risk for ischemic stroke in primary SS patients compared to the normal population, but more studies are needed to clarify the association between these two conditions.