title: Cardiovascular disease risk burden in primary Sjögren's syndrome: results of a population-based multicentre cohort study.
abstract: OBJECTIVE
  Systemic autoimmune diseases, in particular systemic lupus erythematosus and rheumatoid arthritis, are characterized by a high risk of premature cardiovascular (CV) events. Disease-related characteristics and traditional CV disease risk factors may contribute to atherosclerotic damage. However, there are limited data on the risk of overt CV events in primary Sjögren's syndrome (pSS).
  
  
  METHODS
  We retrospectively analysed a cohort of patients with 1343 pSS. Disease-related clinical and laboratory data, traditional CV disease risk factors and overt CV events were recorded. Prevalence of traditional CV disease risk factors and of major CV events was compared between a subgroup of 788 female patients with pSS aged from 35 to 74 years and 4774 age-matched healthy women.
  
  
  RESULTS
  Hypertension and hypercholesterolaemia were more prevalent, whereas smoking, obesity and diabetes mellitus were less prevalent, in women with pSS than in control subjects. Cerebrovascular events (2.5% vs. 1.4%, P = 0.005) and myocardial infarction (MI) (1.0% vs. 0.4%, P = 0.002) were more common in patients with pSS. In the whole population, central nervous system involvement (odds ratio (OR) 5.6, 95% confidence interval (CI) 1.35-23.7, P = 0.02) and use of immunosuppressive therapy (OR 1.9, 95% CI 1.04-3.70, P = 0.04) were associated with a higher risk of CV events. Patients with leucopenia had a higher risk of angina (P = 0.01).
  
  
  CONCLUSIONS
  pSS is associated with an increased risk of cerebrovascular events and MI. Disease-related clinical and immunological markers may have a role in promoting CV events.
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Bartoloni
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Baldini
authors.affiliation: Unit of Internal Medicine, Department of Medicine, Terni University Hospital, Terni, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Schillaci
authors.affiliation: Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Quartuccio
authors.affiliation: Rheumatology Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Priori
authors.affiliation: Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Carubbi
authors.affiliation: Internal Medicine, Endocrine and Metabolic Sciences Section, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Bini
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Alunno
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bombardieri
authors.affiliation: Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy.
authors.forename: S
authors.initials: S
authors.lastname: De Vita
authors.affiliation: Rheumatology Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Valesini
authors.affiliation: Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Giacomelli
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Gerli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012859:Sjogren's Syndrome / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Sjögren's syndrome; atherosclerosis; autoimmune disease; cardiovascular disease risk factors