Risk of venous, arterial, and rare thrombotic events in adults with Sjögren's disease: a systematic review and meta-analysis.

Sjögren's disease (SjD) is associated with increased thrombotic and cardiovascular risk. We systematically reviewed and meta-analyzed venous, arterial, and rare vascular outcomes in SjD. Following PRISMA 2020 (PROSPERO registered), we searched major databases without language restrictions, extracted adjusted estimates, and graded certainty using GRADE. Twelve studies (> 426,000 participants) met the criteria. Venous thromboembolism (VTE) showed a consistent, clinically important increase (≈ twofold). Arterial outcomes - ischemic stroke, myocardial infarction, and composite major adverse cardiovascular events - were heterogeneous, varying by age and geographic region. Heart failure, predominantly with preserved ejection fraction, was increased across settings. Rare events (e.g., cerebral venous thrombosis, thrombotic microangiopathy) were described narratively. Sjögren's disease is associated with substantially increased venous thrombotic risk, variable arterial associations, and an under-recognized burden of heart failure. Clinical care should combine risk-stratified VTE prevention with rigorous cardiovascular risk management. Research priorities include harmonized, multi-ethnic cohorts and prospective trials testing time-limited thromboprophylaxis during high-risk windows.