Risk of Cardiovascular Disease Among Patients With Sarcoidosis: A Population-Based Retrospective Cohort Study

Background/Purpose: Several epidemiologic studies have demonstrated an increased incidence of atherosclerotic cardiovascular disease (CVD) among patients with chronic inflammatory disorders such as rheumatoid arthritis and systemic lupus erythematosus. However, data on sarcoidosis, another relatively common immune-mediated chronic inflammatory disorder, are still limited.

Methods: 345 patients (50% female; 90% Caucasian, 5% African-American; mean age 45.6 years) with incident sarcoidosis in 1976-2013 in a geographically well-defined population were identified based on comprehensive individual medical record review. Inclusion required physician diagnosis supported by histopathology, compatible clinical presentation, and exclusion of other granulomatous diseases. 345 sex and age-matched comparators (50% female; 95% Caucasian, 1% African-American; mean age 45.4 years) were also identified from the same underlying population. Medical records of both cases and comparators were individually reviewed for CVD including coronary artery disease (CAD), congestive heart failure (CHF), atrial fibrillation (AF), cerebrovascular accident (CVA), transient ischemic attack (TIA), peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA). The prevalence of all and individual CVD prior to index date was compared between the 2 groups using Fisher’s exact test. The cumulative incidence of all and individual CVD adjusted for the competing risk of death was estimated. Cox proportional hazards models with adjustment for age, sex, calendar year, current smoking, diabetes mellitus, hypertension, dyslipidemia and obesity were used to compare the rate of development of CVD, individually and in combination, between cases and comparators.

Results: The prevalence of overall and individual CVD prior to index date was not significantly different between 2 groups (p-value = 0.21 for overall CVD).  Adjusting for age, sex and calendar year, the risk of incident CVD after index date was significantly elevated among patients with sarcoidosis with adjusted hazard ratio (HR) of 1.57 (95% CI, 1.15 – 2.16). Further adjustment for current smoking, diabetes mellitus, hypertension, dyslipidemia and obesity yielded adjusted HR of 1.66 (95% CI, 1.09 – 2.55). Sensitivity analysis including only CVD that occurred at least 6 months after index date to reduce the likelihood of detection bias was also performed.  The adjusted HR for overall CVD slightly decreased to 1.50 and remained statistically significant (95% CI, 1.06 – 2.06). Significantly increased risk was also observed in some individual CVD as shown in table 1.   

Conclusion: Patients with sarcoidosis have a higher risk of CVD. How this risk should be addressed in clinical practice requires further investigation.