A RECENT study of medical records from the Taiwan National Health Insurance Research Database (NHIRD) has identified a heightened risk of cardiovascular (CV) events and all-cause mortality in patients with syphilis, compared to those without.
The database of medical records (2010–2015) comprised 20,601 patients with syphilis (74% males; mean age: 47.49 years) with no history of CV events or HIV, and 20,601 patients without syphilis (74% males; mean age: 47.85 years), pair-matched to the experimental group. Victor Chien-Chia Wu, Chang Gung Memorial Hospital, Taoyuan City, Taiwan, and colleagues recorded CV events and deaths in both groups on or before 31st December 2015.
Among the experimental cohort, ischaemic stroke was the most prominent CV event when compared to the control group, totalling 908 events (absolute rate [AR]: 4.06 per 1,000 person-years), and 506 events (hazard ratio [HR]: 1.68), respectively. Likewise, events of myocardial infarction (experimental versus control: AR: 1.20; HR: 1.38; relative risk [RR]: 38%; 95% confidence interval [CI]: 1.19–1.60; p<0.001), heart failure (AR: 3.06; HR: 1.88; RR: 88%; 95% CI: 1.64–2.14; p<0.001), aortic regurgitation (AR: 0.28; HR: 1.81; RR: 81%; 95% CI: 1.18–2.75; p<0.006), atrial fibrillation (RR: 45%; 95% CI: 1.20–1.76; p<0.001), ischaemic stroke (RR: 68%; 95% CI; 1.52–1.87; p<0.001), haemorrhagic stroke (RR: 114%; 95% CI: 1.74–2.64; p<0.001), venous thromboembolism (RR: 67%; 95% CI: 1.23–2.26; p<0.001), cardiovascular death (RR: 155%; 95% CI: 2.11–3.08; p<0.001), and all-cause death (RR: 196%; 95% CI: 2.74–3.19; p<0.001) were increased in patients with syphilis. The risk of aneurysm and dissection of the aorta was not significantly heightened in the experimental group compared to the control group.
The authors noted that, while previous studies have identified the same connection between syphilis and CV complications, “these findings are predominantly based on case reports and case series, lacking large-scale studies. To address this research gap, we utilised the Notifiable Infectious Diseases (NID) database from the Taiwan Centers for Disease Control (CDC), linked to the National Health Insurance (NHI) claims data, to investigate the association between syphilis and cardiovascular events and mortality.”
Wu and colleagues conclude by emphasising the importance of careful evaluation and timely management of CV risks in patients with syphilis. Indeed, due to the extensive burden and lethality of CV events, prompt, continuous monitoring of patients following formal diagnosis is crucial, to mitigate the occurrence of CV complications and reduce mortality rates.
Reference
Wu VC et al. Syphilis and cardiovascular risk: a Taiwanese registry. Eur Heart J. 2024; DOI: 10.1093/eurheartj/ehae183.
