Abstract

Background/Purpose: In rheumatoid arthritis and systemic lupus erythematosus, cardiovascular disease is frequently a major cause of mortality or morbidity. Studies have shown that acute systemic inflammation and chronic systemic vasculitis are associated with endothelial dysfunction and atherosclerotic plaque formation, subsequently leading to cardiovascular disease. The studies of atherosclerosis in primary Sjogren syndrome (PSS) are still inconclusive to date. This meta-analysis aimed to explore the association of subclinical atherosclerosis and arterial stiffness in PSS.

Methods: A comprehensive search of the CENTRAL, MEDLINE and Embase databases was performed from 2000 through January 2017. The inclusion criterion was observational studies evaluating the association between primary Sjogren syndrome, subclinical atherosclerosis and arterial stiffness by measuring pulse wave velocity (PWV) and intima media thickness (IMT). Definitions of PSS and methods to assess PWV and IMT were recorded for each study.  Different locations of IMT were assessed including common carotid, internal carotid, and femoral arteries. Pooled mean difference (MD) of PWV and IMT and 95% confidence interval (CI) were calculated using a random-effect meta-analysis. The between-study heterogeneity of effect size was quantified using the Q statistic and I².

Results: Data were extracted from 10 observational studies involving 789 subjects. Pooled result demonstrated a significant increase in PWV in patients who have PSS compared with controls (MD=1.30 m/s; 95% CI: 0.45 – 2.15, p-value=0.003, I² = 82%). Patients with PSS also have higher IMT (MD=0.10 mm; 95% CI: 0.07-0.14, p-value<0.01, I² = 49%).

Conclusion: Our study suggests that PSS is associated with arterial stiffness and subclinical atherosclerosis. Further studies need to be conducted in order to find the correlation of subclinical atherosclerosis in PSS with cardiovascular event, the pathophysiologic changes of arterial stiffness in PSS, and the benefit of statins, because controlling cardiovascular risk factors or disease activity could potentially help avoid progression of atherosclerosis to an overt cardiovascular disease.