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Primary Sjögren’s syndrome and risk of ischemic stroke: a nationwide study

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Abstract

Few studies are available on the risk of ischemic stroke after a diagnosis of primary Sjögren’s syndrome (PSS). This study investigated whether PSS increased the risk of ischemic stroke in a large, nationwide cohort. Data for 4,276 patients who were newly diagnosed with PSS from 2000 to 2006 and who did not have a stroke prior to diagnosis of PSS were obtained from the Registry of Catastrophic Illness in Taiwan. For each PSS patient, data for ten controls (matched by age, gender, comorbidities, and enrollment date) without systemic autoimmune disease or previous stroke were obtained from the Longitudinal Health Insurance 2000 database. All study subjects were followed up from the date of enrollment until they developed ischemic stroke, died, or until the end of 2006, whichever was earliest. To investigate if PSS was an independent factor in determining the risk of developing ischemic stroke, a Cox regression model was used with adjustment for age, gender, and comorbid disorders. Among 4,276 PSS patients and 42,760 controls, 669 subjects (51 PSS patients and 618 controls) developed ischemic stroke during the mean 3.7-year follow-up period (interquartile range 2.2–5.2 years). Patients with PSS and controls had a similar incidence of ischemic stroke occurrence (3.17/1,000 vs. 3.90/1,000 person years). Multivariate analysis adjusted for baseline covariates indicated that PSS did not increase the risk of ischemic stroke (adjusted hazard ratio: 0.84, 95 % confidence interval: 0.63–1.12, P = 0.244). PSS is not associated with an increased risk of ischemic stroke subsequent to diagnosis.

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References

  1. Sherer Y, Zinger H, Shoenfeld Y (2010) Atherosclerosis in systemic lupus erythematosus. Autoimmunity 43:98–102

    Article  CAS  PubMed  Google Scholar 

  2. Fox RI (2005) Sjogren’s syndrome. Lancet 366:321–331

    Article  CAS  PubMed  Google Scholar 

  3. Helmick CG, Felson DT, Lawrence RC et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis Rheum 58:15–25

    Article  PubMed  Google Scholar 

  4. Zhang NZ, Shi CS, Yao QP et al (1995) Prevalence of primary Sjogren’s syndrome in China. J Rheumatol 22:659–661

    CAS  PubMed  Google Scholar 

  5. Nordmark G, Alm GV, Ronnblom L (2006) Mechanisms of disease: primary Sjogren’s syndrome and the type I interferon system. Nat Clin Pract Rheumatol 2:262–269

    Article  CAS  PubMed  Google Scholar 

  6. Vitali C, Bombardieri S, Jonsson R et al (2002) Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American–European consensus group. Ann Rheum Dis 61:554–558

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Andonopoulos AP, Lagos G, Drosos AA et al (1990) The spectrum of neurological involvement in Sjogren’s syndrome. Br J Rheumatol 29:21–23

    Article  CAS  PubMed  Google Scholar 

  8. Morgen K, McFarland HF, Pillemer SR (2004) Central nervous system disease in primary Sjogren’s syndrome: the role of magnetic resonance imaging. Semin Arthritis Rheum 34:623–630

    Article  PubMed  Google Scholar 

  9. Chai J, Logigian EL (2010) Neurological manifestations of primary Sjogren’s syndrome. Curr Opin Neurol 23:509–513

    Article  PubMed  Google Scholar 

  10. Martinez S, Caceres C, Mataro M et al (2010) Is there progressive cognitive dysfunction in sjogren syndrome? A preliminary study. Acta Neurol Scand 122:182–188

    Article  CAS  PubMed  Google Scholar 

  11. Gokcay F, Oder G, Celebisoy N et al (2008) Headache in primary sjogren’s syndrome: a prevalence study. Acta Neurol Scand 118:189–192

    Article  CAS  PubMed  Google Scholar 

  12. Lodde BM, Sankar V, Kok MR et al (2006) Serum lipid levels in Sjogren’s syndrome. Rheumatology (Oxford) 45:481–484

    Article  CAS  Google Scholar 

  13. Vaudo G, Bocci EB, Shoenfeld Y et al (2005) Precocious intima-media thickening in patients with primary Sjogren’s syndrome. Arthritis Rheum 52:3890–3897

    Article  PubMed  Google Scholar 

  14. Weng MY, Huang YT, Liu MF et al (2012) Incidence of cancer in a nationwide population cohort of 7852 patients with primary Sjogren’s syndrome in Taiwan. Ann Rheum Dis 71:524–527

    Article  PubMed  Google Scholar 

  15. Chiang CH, Huang CC, Chan WL et al (2011) Association between mycoplasma pneumonia and increased risk of ischemic stroke: a nationwide study. Stroke J Cereb Circ 42:2940–2943

    Article  Google Scholar 

  16. Chen HJ, Bai CH, Yeh WT et al (2006) Influence of metabolic syndrome and general obesity on the risk of ischemic stroke. Stroke J Cereb Circ 37:1060–1064

    Article  Google Scholar 

  17. Shoenfeld Y, Gerli R, Doria A et al (2005) Accelerated atherosclerosis in autoimmune rheumatic diseases. Circulation 112:3337–3347

    Article  PubMed  Google Scholar 

  18. de Leeuw FE, de Groot JC, Oudkerk M et al (1999) A follow-up study of blood pressure and cerebral white matter lesions. Ann Neurol 46:827–833

    Article  PubMed  Google Scholar 

  19. Buyck JF, Dufouil C, Mazoyer B et al (2009) Cerebral white matter lesions are associated with the risk of stroke but not with other vascular events: the 3-city Dijon study. Stroke J Cerebral Circ 40:2327–2331

    Article  Google Scholar 

  20. Coates T, Slavotinek JP, Rischmueller M et al (1999) Cerebral white matter lesions in primary Sjogren’s syndrome: a controlled study. J Rheumatol 26:1301–1305

    CAS  PubMed  Google Scholar 

  21. Escudero D, Latorre P, Codina M et al (1995) Central nervous system disease in Sjogren’s syndrome. Ann Med Interne 146:239–242

    CAS  Google Scholar 

  22. Ramos-Casals M, Solans R, Rosas J et al (2008) Primary sjogren syndrome in spain: clinical and immunologic expression in 1010 patients. Medicine 87:210–219

    Article  CAS  PubMed  Google Scholar 

  23. Gono T, Kawaguchi Y, Katsumata Y et al (2011) Clinical manifestations of neurological involvement in primary Sjogren’s syndrome. Clin Rheumatol 30:485–490

    Article  PubMed  Google Scholar 

  24. Perez-De-Lis M, Akasbi M, Siso A et al (2010) Cardiovascular risk factors in primary Sjogren’s syndrome: a case–control study in 624 patients. Lupus 19:941–948

    Article  CAS  PubMed  Google Scholar 

  25. Zoller B, Li X, Sundquist J et al (2012) Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from sweden. BMC Neurol 12:41

    Article  PubMed Central  PubMed  Google Scholar 

  26. Chiu CC, Huang CC, Chan WL, Chung CM, Huang PH, Lin SJ, Chen JW, Leu HB (2012) Increased risk of ischemic stroke in patients with systemic lupus erythematosus: a nationwide population-based study. Intern Med 51:17–21

    Article  PubMed  Google Scholar 

  27. Pasoto SG, Chakkour HP, Natalino RR et al (2012) Lupus anticoagulant: a marker for stroke and venous thrombosis in primary Sjogren’s syndrome. Clin Rheumatol 31(9):1331–8

    Article  PubMed  Google Scholar 

  28. Theander E, Manthorpe R, Jacobsson LT (2004) Mortality and causes of death in primary Sjogren’s syndrome: a prospective cohort study. Arthritis Rheum 50:1262–1269

    Article  PubMed  Google Scholar 

  29. Chen PL, Wang PY, Sheu WH et al (2006) Changes of brachial flow-mediated vasodilation in different ischemic stroke subtypes. Neurology 67:1056–1058

    Article  CAS  PubMed  Google Scholar 

  30. Gerli R, Vaudo G, Bocci EB et al (2010) Functional impairment of the arterial wall in primary Sjogren’s syndrome: combined action of immunologic and inflammatory factors. Arthritis Care Res 62:712–718

    Article  Google Scholar 

  31. Rachapalli SM, Kiely PD, Bourke BE (2009) Prevalence of abnormal ankle brachial index in patients with primary Sjogren’s syndrome. Clin Rheumatol 28:587–590

    Article  PubMed  Google Scholar 

  32. Banerjee A, Fowkes FG, Rothwell PM (2010) Associations between peripheral artery disease and ischemic stroke: implications for primary and secondary prevention. Stroke J Cereb Circ 41:2102–2107

    Article  Google Scholar 

  33. Ramos-Casals M, Tzioufas AG, Stone JH et al (2010) Treatment of primary Sjogren’s syndrome: a systematic review. JAMA 304:452–460

    Article  CAS  PubMed  Google Scholar 

  34. Lin HC, Lin YJ, Liu TC et al (2007) Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey. J Urban Health Bull NY Acad Med 84:604–614

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Da-Chien General Hospital, Miaoli, Taiwan

    Chia-Hung Chiang

  2. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chia-Hung Chiang, Chin-Chou Huang, Chien-Yi Hsu, Wan-Leong Chan, Po-Hsun Huang, Shing-Jong Lin, Jaw-Wen Chen & Hsin-Bang Leu

  3. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan

    Chia-Hung Chiang, Chin-Chou Huang, Chien-Yi Hsu, Po-Hsun Huang, Shing-Jong Lin, Jaw-Wen Chen & Hsin-Bang Leu

  4. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Chia-Hung Chiang, Po-Hsun Huang, Shing-Jong Lin & Hsin-Bang Leu

  5. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chia-Jen Liu

  6. Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan

    Chia-Jen Liu

  7. Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chia-Jen Liu

  8. Department of Family Medicine and Department of Geriatric Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Ping-Jen Chen

  9. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan

    Chin-Chou Huang, Shing-Jong Lin & Jaw-Wen Chen

  10. Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan

    Chin-Chou Huang & Jaw-Wen Chen

  11. Healthcare and Management Center, Division of Cardiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei, Taiwan

    Wan-Leong Chan & Hsin-Bang Leu

  12. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Tzeng-Ji Chen

  13. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chia-Hung Chiang, Chia-Jen Liu, Ping-Jen Chen, Chin-Chou Huang, Chien-Yi Hsu, Wan-Leong Chan, Po-Hsun Huang, Tzeng-Ji Chen, Shing-Jong Lin, Jaw-Wen Chen & Hsin-Bang Leu

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  1. Chia-Hung Chiang
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  2. Chia-Jen Liu
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  4. Chin-Chou Huang
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  6. Wan-Leong Chan
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  7. Po-Hsun Huang
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  8. Tzeng-Ji Chen
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  11. Hsin-Bang Leu
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Corresponding author

Correspondence to Hsin-Bang Leu.

Additional information

Chiang and Liu contribute equally to this work

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Chiang, CH., Liu, CJ., Chen, PJ. et al. Primary Sjögren’s syndrome and risk of ischemic stroke: a nationwide study. Clin Rheumatol 33, 931–937 (2014). https://doi.org/10.1007/s10067-014-2573-7

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  • DOI: https://doi.org/10.1007/s10067-014-2573-7

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