Cardiovascular Risk in Women with Sjögren's Disease

Sjögren's disease (SjD) is increasingly recognized as a systemic condition with cardiovascular consequences, yet its vascular manifestations can be difficult to distinguish from familiar symptoms such as fatigue, dyspnea, and pain. For women, who account for approximately 85%–90% of patients, this challenge may be compounded by hormonal transitions and differences in cardiovascular symptom recognition. A review published in Current Problems in Cardiology examines how immune activation, sex hormones, and clinical factors may shape cardiovascular risk in women with SjD.

Inflammation and Hormonal Changes May Converge on Vascular Risk

The authors conducted a structured narrative review of literature published between January 2010 and July 2026, supplemented by earlier relevant studies.

Observational evidence links SjD to endothelial dysfunction, arterial stiffness, and subclinical atherosclerosis. A meta-analysis involving more than 67,000 patients identified increased cardiovascular morbidity, including ischemic heart disease, cerebrovascular events, heart failure, and venous thromboembolism, although cardiovascular mortality was not significantly elevated.

Chronic immune activation may contribute to vascular injury through B-cell hyperactivity, interferon signaling, oxidative stress, and inflammatory pathways. However, no SjD-specific inflammatory biomarker has been validated for cardiovascular risk prediction.

Hormonal changes may add another dimension. SjD is commonly diagnosed between ages 50 and 60, overlapping with menopause. Declining estrogen levels can adversely affect endothelial function and cardiometabolic regulation, potentially interacting with systemic inflammation. X-linked immune mechanisms may also contribute to female susceptibility, although their relationship with cardiovascular outcomes remains largely hypothetical.

Cardiovascular Manifestations Extend Beyond Atherosclerosis

The cardiovascular spectrum in SjD includes possible coronary microvascular dysfunction, myocardial abnormalities, arrhythmias, autonomic dysfunction, and pulmonary hypertension.

Coronary microvascular dysfunction and ischemia with nonobstructive coronary arteries are relevant considerations in symptomatic women, but direct SjD-specific evidence remains limited. Similarly, heart failure with preserved ejection fraction warrants consideration in older women with unexplained dyspnea, although it has not been established as a distinct SjD-associated phenotype.

Pulmonary hypertension, while uncommon, deserves particular attention in patients with interstitial lung disease. Progressive dyspnea, reduced exercise tolerance, and fatigue may resemble systemic SjD manifestations, potentially delaying recognition of cardiopulmonary complications.

Symptom Overlap Complicates Cardiovascular Recognition

Women with SjD may experience fatigue, palpitations, chest discomfort, dizziness, or reduced exercise tolerance that clinicians attribute to autoimmune disease, autonomic dysfunction, or psychological distress.

The authors caution against automatically classifying these symptoms as noncardiac. Persistent or unexplained cardiopulmonary complaints warrant evaluation through established cardiovascular pathways, particularly when symptoms appear disproportionate to rheumatologic disease activity.

Traditional risk factors, including hypertension, dyslipidemia, diabetes, smoking, and adiposity, remain central to assessment, alongside systemic organ involvement, medication exposure, and reproductive history.

Integrating Cardiovascular Assessment into SjD Care

Rather than recommending universal cardiovascular screening, the review proposes a risk- and symptom-driven approach:

• Chest pain may warrant ischemia evaluation, including assessment for microvascular disease when appropriate.
• Unexplained dyspnea or suspected pulmonary hypertension may prompt echocardiography and specialist evaluation.
• Palpitations, presyncope, or orthostatic symptoms may justify electrocardiography, ambulatory monitoring, or autonomic testing.

Menopausal hormone therapy should not be initiated specifically for cardiovascular prevention, and immunomodulatory treatments have not demonstrated cardiovascular outcome benefits specifically in SjD.

The evidence remains predominantly observational, with heterogeneous outcomes and limited sex-disaggregated analyses. The proposed framework is therefore not a validated screening algorithm.

For clinicians, the practical message is to integrate conventional cardiovascular prevention with closer attention to unexplained symptoms and systemic disease manifestations. Prospective studies are needed to determine which SjD-related characteristics improve risk prediction and guide individualized follow-up.

Reference
Coppi F, Angeli F, Bucciarelli V, et al. Cardiovascular phenotypes in women with Sjögren disease: hormonal, immune, and clinical perspectives. Curr Probl Cardiol. Published online October 15, 2026. doi:10.1016/j.cpcardiol.2026.103481