Concomitant Ro/SSA and La/SSB antibodies are biomarkers for the risk of venous thromboembolism and cerebral infarction in primary Sjögren's syndrome

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OBJECTIVES: To assess the risk of incident cardiovascular disease in patients with primary Sjögren's syndrome, overall and stratified by Ro/SSA and La/SSB autoantibody status.

METHODS: A cohort of patients with primary Sjögren's syndrome in Sweden (n=960) and matched controls from the general population (n=9,035) were included, and data extracted from the National Patient Register to identify events of myocardial infarction, cerebral infarction, and venous thromboembolism. Hazard ratios were estimated using cox proportional hazard regressions.

RESULTS: During a median follow-up of 9.5 years, the overall hazard ratio (HR) was 1.6 (95% CI 1.2-2.1) for myocardial infarction, 1.2 (95% CI 0.9-1.7) for cerebral infarction, and 2.1 (95% CI 1.6-2.9) for venous thromboembolism. Patients positive for both Ro/SSA and La/SSB autoantibodies had a substantially higher risk of cerebral infarction (HR 1.7, 95% CI 1.0-2.9) and venous thromboembolism (HR 3.1, 95% CI 1.9-4.8) than the general population. These risks were not significantly increased in Ro/SSA and La/SSB negative patients. Among autoantibody positive patients, the highest HR of cerebral infarction was seen after ≥ 10 years disease duration (HR 2.8, 95% CI 1.4-5.4), while the HR for venous thromboembolism was highest 0-5 years after disease diagnosis (HR 4.7, 95% CI 2.3-9.3) and remained high throughout disease duration.

CONCLUSIONS: Primary Sjögren's syndrome is associated with a markedly increased risk of cardiovascular disease and the presence of Ro/SSA and La/SSB autoantibodies identify the subgroup of patients carrying the highest risk. These findings suggest that monitoring and prevention of cardiovascular disease in this patient group should be considered. This article is protected by copyright. All rights reserved.


  • Johannes Mofors
  • Marie Holmqvist
  • Linnea Westermark
  • Albin Björk
  • Marika Kvarnström
  • Helena Forsblad-d'Elia
  • Sara Magnusson Bucher
  • Per Eriksson
  • Elke Theander
  • Thomas Mandl
  • Marie Wahren-Herlenius
  • Gunnel Nordmark
External organisations
  • Karolinska Institutet
  • Karolinska University Hospital
  • Uppsala University
  • Umeå University
  • Örebro University
  • Linköping University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)458-468
JournalJournal of Internal Medicine
Issue number4
Early online date2019 May 25
Publication statusPublished - 2019
Publication categoryResearch