Abstract

Background/Purpose: Studies have demonstrated that acute systemic inflammation and chronic systemic vasculitis are associated with endothelial dysfunction and atherosclerotic plaque formation, subsequently leading to cardiovascular or cerebrovascular disease. In rheumatoid arthritis and systemic lupus erythematosus, the tendency of atherosclerosis is a major cause of mortality. Patients with primary Sjogren syndrome (PSS) may have a higher frequency of subclinical atherosclerosis, but studies on cardiovascular or cerebrovascular events in this population are limited with conflicting results. This meta-analysis aimed to explore the risk of cardiovascular and cerebrovascular event in PSS.

Methods: A comprehensive search in the CENTRAL, MEDLINE and Embase databases was performed from 1990 through January 2017. The inclusion criterion was observational studies evaluating the association between PSS and cardiovascular disease or cerebrovascular event. PSS is defined using American College of Rheumatology or American European Consensus criteria. Outcomes are diagnosis of ischemic heart disease, myocardial infarction, ischemic stroke or hemorrhagic stroke. Pooled odds ratio (OR) of cerebrovascular event or cardiovascular disease and their 95% confidence interval (CI) were calculated using a random-effect meta-analysis to compare risk between those who have PSS and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I².

Results: Data were extracted from five observational studies involving 94,426 subjects. Pooled result demonstrated no significant difference in risk of having cardiovascular disease or cerebrovascular event in patients who have PSS compared with controls (OR=1.24; 95% CI: 0.96-1.61, p-value=0.10, I² = 67%). Subgroup analyses showed no difference in risk for cerebrovascular event (OR=1.26; 95% CI: 0.93-1.69, p-value=0.13, I² = 72%), and cardiovascular disease (OR=1.30; 95% CI: 0.67-2.53, p-value=0.43, I² = 72%).

Conclusion: Our study has not shown an increased risk of cardiovascular or cerebrovascular event in patient with PSS. Further studies need to be conducted in order to find the correlation of subclinical atherosclerosis in PSS with cardiovascular or cerebrovascular event.