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Background: Sjögren’s syndrome (SS) is associated with numerous comorbidities, including cardiovascular (CV) diseases. CV events are preceded by subclinical damage to the arterial walls caused by structural and functional changes associated with atherosclerosis. The latest research showed a significant prevalence of subclinical atherosclerosis in patients with primary SS (pSS), indicating this disease as an independent risk factor for early vascular damage. Carotid intima-media thickness (CIMT) has often been considered as a surrogate biomarker of early atherosclerosis and is widely used for cardiovascular risk stratification. Homocysteine (Hcy) is a risk factor for atherosclerotic vascular disease and positively correlated with the degree of arteriosclerosis in general population. In pSS, there is insufficient data on Hcy, its association with atherosclerosis, including CIMT as surrogate of early atherosclerosis, and with clinical parameters of the disease.
Objectives: The aim of this study is to determine the values and association of Hcy and CIMT in patients with pSS, as well as their association with activity and chronic damage.
Methods: In this cross-sectional study, 48 consecutive patients with pSS were compared with 46 healthy controls matched by age, sex, smoking history and body mass index. Demographic and clinical characteristics of the patients are presented in Table 1. Classic cardiovascular risk factors were assessed in both groups. Disease activity was measured using the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), while irreversible damage in pSS was assessed using the Sjögren’s Syndrome Disease Damage Index (SSDDI). Serum Hcy concentration was measured using chemiluminescent microparticle immunoassay. The presence of subclinical atherosclerosis was determinted with CIMT assessed by carotid doppler ultrasound.
Results: Hcy was significantly higher in the pSS group compared to controls [11.28 µmol/l (8.93-14.06) vs. 9.46 (8.64-10.98), p =0.015], as well as maximum CIMT mean values in mm [1 (0.90-1.31) vs. 0.9 (0.80-1.10), p =0.037]. The pSS group had statisticaly higher number of plaques compared to healthy control [14 (29.2%) vs. 5 (10.9%), p =0.028]. Correlation analysis showed that Hcy levels have positive correlation with triglycerides ( r =0.204, p =0.048) and maximum CIMT ( r =0.231, p =0.046). Maximum CIMT have positive correlation with age ( r =0.416, p <0.0001), systolic blood pressure ( r =0.293, p =0.004) and SSDDI ( r =0.351, p =0.014). Multiple logistic regression analysis showed that Hcy levels are independent factor for predicting Sjogren’s syndrome [OR 1.28 (95% CI 1.069 to 1.545), p =0.007].
Conclusion: Patients with pSS have a higher risk for the development of subclinical atherosclerosis, as indicated by a higher value of CIMT and significant relationship between CIMT and Hcy. The results of this study suggest that routine assessment of plasma Hcy levels and measurement of CIMT would be useful to identify individuals with higher risk of accelerated atherosclerosis in patients with pSS.
REFERENCES: NIL
Baseline characteristics and laboratory parameters of pSS patients and controls.
| Parameter | pSS group
| Control group
| p * |
|---|---|---|---|
| Male gender (N, %) | 4 (8.3) | 3 (6.5) | 0.953 |
| Age (years) | 60.5 ± 9.6 | 57.4 ± 9.9 | 0.129 |
| Body mass index (kg/m 2 ) | 24.8 ± 3.4 | 25.4 ± 3.1 | 0.418 |
| SBP (mmHg) | 127.8 ± 16.8 | 119.2 ± 13.4 | 0.007 |
| DBP (mmHg) | 81.6 ± 7.4 | 77.8 ± 8.0 | 0.018 |
| Smokers (N, %) | 8 (16.7) | 7 (15.2) | 0.928 |
| Disease duration (years) † | 6.5 (4.0-11.0) | - | - |
| ESSDAI | 2 (1-3) | - | - |
| SSDDI | 2 (1.5-3.0) | - | - |
| Plaque | 14 (29.2) | 5 (10.9) | 0.028 |
SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ESSDAI: EULAR Primary Sjögren’s Syndrome Disease Activity Index; SSDDI: Sjögren’s Syndrome Disease Damage Index. ESR: Erythrocyte sedimentation rate; hsCRP: high sensitivity C-reactive protein; TC: total cholesterol; LDL: low density lipoprotein; TG: triglycerides; HDL: high density lipoprotein;
Data are presented as whole number (percentage), mean ± standard deviation or median (IQR)
*chi-square test (Fisher’s exact test), t-test for independent samples
†time period from the initial diagnosis
Acknowledgements: NIL.
Disclosure of Interests: None declared.