The long-term prognostic significance of heart failure in sarcoidosis patients ─ a cohort study

The Association Between Sarcoidosis and Malignancy: A Comprehensive Population-Based Cohort Study

Background: Sarcoidosis is a multisystem granulomatous disorder with a variable clinical course and complications. The relationship between sarcoidosis and malignancies remains unclear, including specific malignancy associations with sarcoidosis and whether the association is short-term, long-term, or a result of misdiagnoses or coincidence. This study investigated the association between sarcoidosis and malignancy by analyzing the varying intervals between the diagnoses of these two conditions to clarify their inter-relationship. Methods: This retrospective cohort study included almost 24,000 sarcoidosis patients and matched controls at a 1:5 ratio in patients diagnosed between 2000 and 2015 in Israel. Patients had a median age of 57 years. Malignancy rates were compared across several timeframes: overall, within one year before or after sarcoidosis diagnosis and more than one year. Logistic regression models were employed to estimate odds ratios for the association between sarcoidosis and malignancy, adjusting for sociodemographic and clinical variables. Results: Sarcoidosis patients had a significantly higher prevalence of malignancies (19.5%) compared to controls (13.6%) (p < 0.001). The association remained significant for both hematologic malignancies (OR: 2.94, 95% CI: 2.41-3.57) and solid malignancies (OR: 1.41, 95% CI: 1.27-1.55). The strongest association was observed with lymphoma, particularly within the first year of sarcoidosis diagnosis (OR: 14.88, 95% CI: 8.83-25.1). Elevated odds for malignancies persisted both within one year and beyond, including sarcoma and soft tissue cancers and genitourinary malignancies. Conclusions: Our study confirms a significant association between sarcoidosis and both hematologic and solid malignancies in both the short and long term across various timeframes. These findings emphasize the need for increased clinical vigilance in sarcoidosis patients and highlight the importance of further research into the shared genetic and environmental mechanisms that may underlie this relationship.

RETRACTED: Association between sarcoidosis and cardiovascular Outcomes: A systematic review and Meta-analysis

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What is known?

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Previous studies showed the prevalence of cardiovascular diseases with sarcoidosis. However, there is limited data quantifying the future risks of these adverse outcomes in patients with a diagnosis of sarcoidosis.

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What is New?

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To the best of our knowledge, this is the first meta-analysis assessed the adverse cardiovascular outcomes in patients with sarcoidosis.

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Our study analyzed 22,539,096 patients and found that the incidence of Atrial Arrhythmia, Ventricular Tachycardia and Heart Failure were significantly higher in patients with sarcoidosis.

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All-cause mortality appeared to be approximately 2-fold higher in patients with sarcoidosis.

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What are the clinical implications?

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In sarcoidosis with cardiac involvement, clinicians should be aware of the increased risk of adverse cardiovascular events in these patients. Additional studies are warranted to study the optimal management approach towards patients with cardiac sarcoidosis.

Background

Sarcoidosis is a chronic inflammatory disorder of unknown etiology associated with high morbidity and mortality. Its association with cardiovascular outcomes is under-documented.

Aim

The aim of this study was to assess the adverse cardiovascular outcomes in patients with sarcoidosis compared with that of non-sarcoidosis.

Methodology

Online databases including PubMed, Embase and Scopus were queried from inception until March 2022. The outcomes assessed included all-cause mortality (ACM) and incidence of ventricular tachycardia (VT), heart failure (HF) and atrial arrhythmias (AA).

Result

A total of 6 studies with 22,539,096 participants (42,763 Sarcoidosis, 22,496,354 Non-Sarcoidosis) were included in this analysis. The pooled prevalence of sarcoidosis was 13.1% (95% CI 1% to 70%). The overall mean age was 47 years. The most common comorbidities were hypertension (12.7% vs 12.5%), and diabetes mellitus (5.5% vs 4%) respectively. The pooled analysis of primary endpoints showed that all-cause mortality (RR, 2.08; 95% CI: 1.17 to 3.08; p = 0.01) was significantly increased in sarcoidosis patients. The pooled analysis of secondary endpoints showed that the incidence of VT (RR, 15.3; 95% CI: 5.39 to 43.42); p < 0.001), HF (RR, 4.96; 95% CI: 2.02 to 12.14; p < 0.001) and AA (RR, 2.55; 95% CI: 1.47 to 4.44); p = 0.01) were significantly higher with sarcoidosis respectively compared to non-sarcoidosis.

Conclusion

Incidence of VT, HF and AA was significantly higher in patients with CS. Clinicians should be aware of these adverse cardiovascular events associated with sarcoidosis.

The Association between Sarcoidosis and Ischemic Heart Disease-A Healthcare Analysis of a Large Israeli Population

(1) Background: Inflammation plays a pivotal role in atherosclerosis, and the association between chronic inflammatory states and ischemic heart disease (IHD) has been shown in several rheumatic diseases. Persistent inflammation might also be a risk factor for IHD in sarcoidosis patients. (2) Methods: Demographic and clinical data of 3750 sarcoidosis patients and 18,139 age- and sex-matched controls were retrieved from the database of Clalit Health Services, Israel’s largest healthcare organization. Variables associated with IHD were assessed by a logistic regression model. To assess for variables that were related to increased risk of all-cause mortality, the Cox proportional hazards method was used, and a log-rank test was performed for survival analysis. (3) Results: Both groups were composed of 64% females with a median age of 56 years. An association between sarcoidosis and IHD was demonstrated by a multivariate analysis (adjusted odds ratio (OR) 1.5; 95% confidence interval (CI) 1.36–1.66). Long-term follow-up revealed increased mortality among sarcoidosis patients: 561 (15%) deaths compared to 1636 (9%) deaths among controls (p < 0.001). Survival analysis demonstrated that sarcoidosis patients were also at increased risk for all-cause mortality compared to controls (multivariate model, adjusted HR 1.93; 95% CI 1.76–2.13).

Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

OBJECTIVES

Previous studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.

METHODS

Sarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003-2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006-2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).

RESULTS

During follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).

CONCLUSIONS

Although low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.