Syphilis and cardiovascular risk: a Taiwanese registry

Abstract Background and Aims Studies on the impact of syphilis on the cardiovascular system in large populations are limited. This study investigated the effects of syphilis on cardiovascular outcomes. Methods Medical records from 2010 to 2015 were retrieved from the Taiwan National Health Insurance Research Database, linked to the Notifiable Infectious Diseases database from the Taiwan Centers for Disease Control. Patients with syphilis were identified, excluding those with missing information, under 20 years of age, or with a history of human immunodeficiency virus infection, acute myocardial infarction, heart failure, aortic regurgitation, replacement of the aortic valve, aneurysm and/or dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, and venous thromboembolism. Primary outcomes included new-onset acute myocardial infarction, heart failure, aortic regurgitation, aneurysm and dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, cardiovascular death, and all-cause mortality. Results A total of 28 796 patients with syphilis were identified from 2010 to 2015. After exclusions and frequency matching, 20 601 syphilis patients and 20 601 non-syphilis patients were analysed. The relative rate (RR) was utilized in the analysis, as the competing risk of death was not considered. Compared with patients without syphilis, patients with syphilis had increased risks of acute myocardial infarction (RR 38%, 95% confidence interval [CI] 1.19–1.60, P < .001), heart failure (RR 88%, 95% CI 1.64–2.14, P < .001), aortic regurgitation (RR 81%, 95% CI 1.18–2.75, P = .006), atrial fibrillation (RR 45%, 95% CI 1.20–1.76, P < .001), ischaemic stroke (RR 68%, 95% CI 1.52–1.87, P < .001), haemorrhagic stroke (RR 114%, 95% CI 1.74–2.64, P < .001), venous thromboembolism (RR 67%, 95% CI 1.23–2.26, P = .001), cardiovascular death (RR 155%, 95% CI 2.11–3.08, P < .001), and all-cause death (RR 196%, 95% CI 2.74–3.19, P < .001) but not for aneurysm and dissection of the aorta. Conclusions This study demonstrates that patients with syphilis have a higher risk of cardiovascular events and all-cause mortality compared with those without syphilis.