{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:59:35Z","timestamp":1792022375019,"version":"4.4.0"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2013NextGenerationEU"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Introduction: Primary Sj\u00f6gren\u2019s (pSS) is an autoimmune disease that affects several organs, especially the heart, and raises cardiovascular risk. Investigating the associations of hemoglobin-to-red cell distribution width (RDW) ratio (HRR), vitamin D status, and cardiac function could provide valuable insights and biomarkers regarding early cardiovascular risk in patients with pSS. Method: This cross-sectional study involved 61 patients diagnosed with pSS based on ACR\/EULAR criteria. Data on demographics, hematological (Hb, RDW), echocardiography, and serum vitamin D levels were collected. Echocardiograms were conducted by trained cardiologists following established guidelines, while vitamin D levels were measured using ELISA. Statistical analyses, including univariate linear regression, were performed with SPSS in order to identify whether HRR tertiles were related to cardiac function and vitamin D status. Results: A study of 61 pSS patients (mean age 59.8 years, 89% female) revealed that patients with a lower hemoglobin-to-RDW ratio (HRR \u2264 0.98) had significantly higher pulmonary artery pressures (PAPs) and lower values for the tricuspid annular plane systolic excursion (TAPSE)\/PAPs ratio, contributing to poor right heart function. These associations were particularly strong in patients with insufficient levels of vitamin D (&lt;30 ng\/mL), while differences in other echocardiographic parameters remained nonsignificant between HRR groups. Conclusions: These findings underscore the clinical value of HRR as a composite biomarker that reflects the interplay between anemia, inflammation, and cardiovascular health in primary Sj\u00f6gren\u2019s disease. They also suggest that vitamin D status may be an important therapeutic consideration to mitigate cardiopulmonary risks in this population.<\/jats:p>","DOI":"10.3390\/life16020190","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T10:41:34Z","timestamp":1769164894000},"page":"190","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hemoglobin-to-Red Cell Distribution Width Ratio and Vitamin D Status as Early Predictors of Cardiovascular Risk in Primary Sj\u00f6gren\u2019s Syndrome"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-6941","authenticated-orcid":false,"given":"Francesca","family":"Coppi","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"},{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Sbarra","sequence":"additional","affiliation":[{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5441-218X","authenticated-orcid":false,"given":"Aurora","family":"Vicenzi","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Campani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Moretti","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0041-3695","authenticated-orcid":false,"given":"Dilia","family":"Giuggioli","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Vacchi","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Spinella","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Aschieri","sequence":"additional","affiliation":[{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Vittoria","family":"Mattioli","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Department of Quality-of-Life, University of Bologna\u2014Alma Mater Studiorum, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Fedele","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Emeritus of Cardiology, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Baccarani","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Medical and Surgical Sciences, Modena Policlinico Hospital, University of Modena and Reggio Emilia, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9118-1262","authenticated-orcid":false,"given":"Marcello","family":"Pinti","sequence":"additional","affiliation":[{"name":"Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8666-4849","authenticated-orcid":false,"given":"Alessandra","family":"Dei Cas","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolic Diseases, Parma University Hospital, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3202-3947","authenticated-orcid":false,"given":"Federica","family":"Fantuzzi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Bigdelu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular, School of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7067-279X","authenticated-orcid":false,"given":"Gianluca","family":"Pagnoni","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Darroudi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"447","DOI":"10.2174\/1570161118666200129125320","article-title":"Primary Sj\u00f6gren\u2019s Syndrome and Cardiovascular Disease","volume":"18","author":"Melissaropoulos","year":"2020","journal-title":"Curr. 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