Understanding Cardiovascular Risk in Primary Sjögren's Syndrome: Essential Insights for Patient Care

Abstract

Sjogren's syndrome (SS) is an autoimmune rheumatic disease that primarily affects women aged 40 to 60. It manifests as either Primary Sjogren's Syndrome (pSS) or Secondary Sjogren's Syndrome (sSS), the latter associated with other connective tissue diseases like Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). pSS is characterized by lymphocytic infiltration leading to symptoms such as dry eyes and mouth, but can also have extra-glandular manifestations affecting various organ systems, including the cardiovascular system. This review highlights the interplay between cardiovascular disease (CVD) risk and pSS, focusing on both traditional and disease-specific risk factors.

Recent studies indicate that pSS patients have an elevated risk of major adverse cardiovascular events (MACEs), influenced by traditional risk factors like hypertension and dyslipidemia, alongside immunological factors unique to pSS. Notably, patients with pSS exhibit higher levels of subclinical atherosclerosis despite similar Framingham Risk Scores compared to the general population. The role of inflammation and immune dysregulation in the pathogenesis of CVD in pSS is explored, emphasizing biomarkers such as calprotectin and DKK1 that link inflammatory processes to atherosclerotic progression.

Therapeutic interventions, including hydroxychloroquine (HCQ), show potential in mitigating cardiovascular risks, while the effects of glucocorticoids and NSAIDs remain contentious. This review underscores the need for a tailored approach to cardiovascular risk assessment in pSS, considering both traditional and unique immunological determinants. The findings call for further research into the mechanisms linking CVD and pSS and the efficacy of targeted therapies in improving cardiovascular outcomes for affected patients.