Pos1458 prevalence of Subclinical Atherosclerosis in Patients With Primary Sjögren’s Syndrome

Abstract

BackgroundIt is well established that patients with inflammatory rheumatic diseases have an increased cardiovascular risk [1]. Most data exists for rheumatoid arthritis, but there are also a few studies for primary Sjoegren’s syndrome (pSS)[2].ObjectivesAim of our study was to investigate the extent of subclinical atherosclerosis in a large group of patients with pSS compared to control subjects without pSS. Secondary, correlations with clinical factors, such as organ involvement or antibody positivity, and disease activity were investigated.MethodsFrom September 2021 to April 2022, pSS patients from the outpatient clinic of our hospital were consecutively included after informed consent. In addition, age- and sex-matched control subjects were recruited in a 2:1 ratio via multimedia call for participation. All pSS patients fulfilled current EULAR classification criteria for pSS and had a disease duration of at least 5 years. Participants with additional rheumatic or inflammatory diseases, tumor disease in the past 5 years, or end-organ manifestations of atherosclerotic disease were excluded. Data collection was performed by standardized questionnaire and Doppler ultrasonography for evaluation of plaque extent and intima-media thickness measurements (cIMT).ResultsAnalysis included data from 199 pSS patients and 100 control subjects. 38 (19.4%) subjects of the pSS cohort were male and the median age was 58.92 years [50.50-65.21]. The median disease duration (since initial manifestation) of pSS patients was 136 months. The cohorts were analyzed for differences regarding to the cardiovascular risk profile: There were no significant differences in age, gender distribution, tobacco consumption, body mass index (BMI), pre-existing arterial hypertension, hypercholesterolemia, or diabetes mellitus. Similarly, there were no differences in LDL cholesterol, HDL cholesterol, or HbA1c in laboratory tests at enrollment. Only a positive family history for cardiovascular disease was significantly more frequent in the pSS cohort (p=0.003).After adjustment via propensity score matching, the pSS cohort was found to have a significantly greater intima-media thickness (p= <0.001). When age was added as a covariate, there was an earlier onset of intima-media thickening recognizable in the pSS patients (p=0.014). Furthermore, there was a significantly more frequent occurrence of plaque in the pSS cohort (p=0.031). pSS-patients had a 1.82times increased odds of having plaque in comparison to the control cohort.Organ involvement in the pSS-cohort was associated with a thicker cIMT (p=0.025) and pSS-patients with organ involvement also showed a 1.74times increased odds of having plaque compared to pSS-patients without organ involvement.ConclusionPSS appears to accelerate the development and progression of atherosclerosis as an independent risk factor. It seems to promote not only an increased incidence of atherosclerotic changes, but also an earlier onset of wall thickening in the sense of vascular aging. An increased risk for patients with organ involvement was observed. Further longitudinal studies are required to answer the question if this subgroup of pSS patients in particular or all pSS patients could benefit of screening with Doppler ultrasonography and preventive medication with HMG-CoA reductase inhibitors or acetyl salicylic acid.References[1]Yong WC, Sanguankeo A, Upala S. Association between primary Sjögren’s syndrome, cardiovascular and cerebrovascular disease: a systematic review and meta-analysis. Clin Exp Rheumatol. 2018 May-Jun;36 Suppl 112(3):190-197. Epub 2018 Mar 19. PMID: 29600936.[2]Garcia AB, Dardin LP, Minali PA, Czapkowsky A, Ajzen SA, Trevisani VF. Asymptomatic Atherosclerosis in Primary Sjögren Syndrome: Correlation Between Low Ankle Brachial Index and Autoantibodies Positivity. J Clin Rheumatol. 2016 Sep;22(6):295-8. doi: 10.1097/RHU.0000000000000413. PMID: 27556236.AcknowledgementsThis study was funded by Else-Kröner-Fresenius foundation and Novartis AG.Disclosure of InterestsNadine Zehrfeld Grant/research support from: Novartis AG, Sabrina Benz: None declared, Anselm Derda: None declared, Sonja Beider: None declared, Emelie Kramer: None declared, Georgios Sogkas: None declared, Tabea Seeliger Grant/research support from: Alnylam Pharmaceuticals, Bristol-Myers Squibb Foundation for Immuno-Oncology, Claudia von Schilling Foundation, CSL Behring, Else Kröner Fresenius Foundation, Novartis, Sanofi Aventis, VHV Stiftung, Abbvie, Gerrit Ahrenstorf: None declared, Alexandra Dopfer-Jablonka: None declared, Thomas Skripuletz Grant/research support from: Alexion, Alnylam Pharmaceuticals, Bayer Vital, Biogen, Celgene, Centogene, CSL Behring, Euroimmun, Janssen, Merck Serono, Novartis, Roche, Sanofi Aventis, Siemens, Sobi, Teva, Torsten Witte Grant/research support from: Abbvie, BMS, Chugai, Galapagos, Janssen, Lilly, Pfizer, UCB and Roche, Kristina Sonnenschein: None declared, Diana Ernst Consultant of: Abbvie, Galapagos, Amgen and Novartis, Grant/research support from: Abbvie, Amgen, BMS, Chugai, Cilag-Janssen, Galapagos, GSK, Medac, Lilly, Pfizer, Novartis, Roche.

Update zum Sjögren-Syndrom: Diagnostik & Therapie

“…Besonderes Augenmerk sollte auch auf dem bei SjS deutlich gesteigerten kardiovaskulären Risiko sowie dem Malignom-Risiko liegen. Mehrere Untersuchungen legen nahe, dass SjS-PatientInnen ein erhöhtes Risiko für subklinische Atherosklerose sowie kardiovaskuläre Erkrankungen haben 2 . So konnte Zippel et al (2022) ein vermehrtes Auftreten ischämischer Schlaganfälle in dieser PatientInnen-Gruppe aufzeigen 3 .…”