Background/Purpose: To evaluate the incidence of cardiovascular and cerebrovascular events (CVEs) in patients with Sjögren’s Disease (SjD), focusing on major adverse cardiovascular events (MACE), defined as non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. Additional objectives were to identify both traditional and disease-specific risk factors associated with CVEs; to assess CV risk using the SCORE2 algorithm and compare predicted versus observed event rates; to examine the impact of CVEs on all-cause mortality; and to determine the prevalence of conventional cardiovascular risk factors (CVRFs) within this population.

Methods: We conducted a prospective, multicenter observational study including 314 patients with SjD who met the 2002 AECG classification criteria. Median follow-up was 9.5 years. Clinical, serological, demographic variables, CVRFs, and CVEs were recorded. Independent predictors of MACE and overall CVEs were identified using multivariate Cox proportional hazards regression models. Cardiovascular risk was estimated using the SCORE2 algorithm. Expected event rates were calculated by summing individual predicted probabilities. CV mortality was compared to the general population using standardized mortality rate (SMR), based on official data from the Spanish National Institute of Statistics. Relative risk (RR) of all-cause mortality was assessed according to the presence of prior or incident CVEs.

Results: Among 314 patients (94.6% women; median age 58.7 [IQR 50.7–67.1]), 29 CV events occurred: pericarditis (1.27%), conduction abnormalities (1.27%), ischemic heart disease (1.59%), heart failure (1.59%), peripheral artery disease (0.95%), and cerebrovascular events (2.55%). Seventeen patients (5.41%) experienced MACE: 7 non-fatal strokes (2.23%), 5 non-fatal myocardial infarctions (1.59%), and 5 cardiovascular deaths (1.59%). Among the 130 patients with complete SCORE2 data, the expected number of events was 5.74 (4.41%), while 11 events (8.46%) were observed, including 6 MACE (4.62%) and 5 non-MACE events (3.85%).Independent predictors of CV events were age (OR 1.06; 95% CI 1.01–1.14), cryoglobulinemia (OR 10.13; 95% CI 1.63–62.88), glucocorticoid use (OR 3.44; 95% CI 1.29–9.19), and antiphospholipid antibodies (OR 5.33; 95% CI 1.15–24.79). Predictors of MACE included age (OR 1.07; 95% CI 1.01–1.14), cryoglobulinemia (OR 10.41; 95% CI 1.37–79.26), and glucocorticoid use (OR 3.53; 95% CI 1.00–12.51). See the prevalence of traditional CVRFs in Table 1. CV mortality accounted for 11.9% of all deaths. The SMR for CV mortality was 5.09 (95% CI 5.08–5.11). Previous CVEs were significantly associated with increased all-cause mortality (RR 3.27; 95% CI 1.90–5.63).

Conclusion: Sjögren’s Disease is associated with a significantly increased incidence of cardiovascular events, exceeding predicted risk estimates. Disease-specific factors—including cryoglobulinemia, glucocorticoid exposure, and the presence of antiphospholipid antibodies—emerge as independent contributors to this elevated burden. Cardiovascular mortality was fivefold higher than expected, and prior CV events were strong predictors of all-cause mortality.

Table 1. Baseline Cardiovascular Risk Factors in the SjögrenSER-PROS Cohort.

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-and-cerebrovascular-risk-in-sjogrens-disease-results-from-a-prospective-multicenter-cohort/