Major adverse cardiovascular events in Sjögren's disease: incidence, associated factors, and impact on mortality in a prospective multicenter cohort.

To determine incidence of major adverse cardiovascular events (MACE: non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death) in Sjögren's disease (SjD); identify traditional and disease-specific factors associated with MACE; describe prevalence of cardiovascular risk factors (CVRFs); explore, descriptively, SCORE2-estimated risk by comparing predicted and observed events; estimate cardiovascular mortality; and assess association between MACE and all-cause mortality. Prospective, multicenter cohort study including 314 patients fulfilling 2002 AECG criteria for SjD, followed for median 9.5 years. Clinical, serological, and cardiovascular data were recorded. Factors associated with MACE were evaluated using multivariable logistic regression models. SCORE2 risk was calculated in patients with complete data, and expected events were compared with observed events. Cardiovascular mortality was expressed as crude rates per 1,000 patient-years. Seventeen patients (5.41%) developed MACE: 7 strokes (2.23%), 5 myocardial infarctions (1.59%), and 5 cardiovascular deaths (1.59%). Twelve additional non-MACE cardiovascular events were recorded. In a complete-case SCORE2 analysis including 130 patients, 5.74 events (4.41%) were predicted and 6 (4.62%) observed. In exploratory multivariable analysis, factors associated with MACE were age (OR 1.09), cryoglobulinemia (OR 10.42), and glucocorticoid use (OR 3.61). CVRFs were common, particularly dyslipidemia (33.1%) and hypertension (26.4%). Crude cardiovascular mortality rate was 1.8 per 1,000 patient-years. MACE was associated with higher all-cause mortality in a relative risk analysis (RR 3.49). MACE affected approximately 5% of patients and was associated with a threefold increase in all-cause mortality. Cryoglobulinemia and glucocorticoids were associated with MACE in multivariable analysis. In exploratory complete-case analysis, SCORE2 showed numerical concordance for atherosclerotic events but did not capture disease-specific risk. These findings support tailored cardiovascular risk assessment and prevention strategies in SjD.