Abstract
Due to conflicting findings in previous studies, it remains unclear whether individuals with sarcoidosis are at a higher relative risk of acute myocardial infarction. In this cohort study, individuals with sarcoidosis and matched general population comparators were followed for acute myocardial infarction in Swedish nationwide registers. A small (20%) risk increase associated with sarcoidosis was identified, which did not markedly vary by age at diagnosis, sex, treatment status around diagnosis, and time since diagnosis. The highest relative risk (1.4) was observed in individuals who received immunosuppressant treatment around the time of sarcoidosis diagnosis. Future studies should examine the clinical characteristics of acute myocardial infarction in these patients and investigate whether early diagnostic or preventive interventions might be beneficial for these patients.
Highlights
Sarcoidosis is a systemic inflammatory disease of unknown etiology that mostly affects adults in their 50’s [1,2]
Sarcoid inflammation ap pears to dysregulate lipid metabolism and accelerate atherosclerosis [3, 4]. Whether these or other pathways lead to higher risks for acute myocardial infarction (AMI) in sarcoidosis compared to the general population remains unclear due to conflicting results in recent epide miologic investigations [5,6]
Using Cox models with attained age as the underlying time scale, we estimated hazard ratios (HR) of AMI comparing sarcoidosis to the general population. They were adjusted for the matching variables and further for birth country (Nordic/non-Nordic/missing), years of education (≤9/10–12/ ≥13/missing), civil status, calendar period (2003–2007/2008–2013), number of National Patient Register (NPR) visits within two years before the first sarcoidosis visit or corresponding period for comparators (0/ 1–3/≥4), family history of AMI or ischemic stroke (≥1 NPR visit or mention as cause of death [Cause of Death Register] in ≥1 biologic parent identified from the Multi-Generation Register; yes/no/no parents identified), and comorbidities defined using NPR and Prescribed Drug Register (PDR) data if applicable
Summary
Sarcoidosis is a systemic inflammatory disease of unknown etiology that mostly affects adults in their 50’s [1,2]. Sarcoid inflammation ap pears to dysregulate lipid metabolism and accelerate atherosclerosis [3, 4]. Whether these or other pathways lead to higher risks for acute myocardial infarction (AMI) in sarcoidosis compared to the general population remains unclear due to conflicting results in recent epide miologic investigations [5,6]. It is unclear whether AMI risk is uniformly increased or varies by age, sex, treatment, or time since sarcoidosis diagnosis. There fore, we conducted a cohort study using Swedish register data to esti mate relative risks of AMI associated with sarcoidosis overall and stratified by age, sex, sarcoidosis treatment status around diagnosis, and time since diagnosis
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