TOPLINE:

Syphilis was independently associated with increased risks for aortic aneurysm or dissection, hemorrhagic stroke, peripheral artery disease, myocardial infarction, and death. These risks were more pronounced in patients with later stages of the disease.

METHODOLOGY:

• Researchers conducted a retrospective study to evaluate the association between syphilis and adverse cardiovascular outcomes.
• They used data from electronic health records of three US hospitals and identified 1469 patients with syphilis and no prior cardiovascular disease, who were followed up for 15 years between January 2011 and July 2025.
• The participants were matched by age, sex, BMI, and comorbidities with 7345 control individuals from the unaffected population. The mean age for both groups was around 50 years, and about 54% were female.
• Primary outcomes included acute myocardial infarction, heart failure, aortic regurgitation, atrial fibrillation, aortic aneurysm or dissection, ischemic stroke, hemorrhagic stroke, peripheral artery disease, and venous thromboembolism.

TAKEAWAY:

• Patients with syphilis had higher risks than control individuals for aortic aneurysm or dissection (hazard ratio [HR], 2.08), ischemic stroke (HR, 1.53), hemorrhagic stroke (HR, 1.92), peripheral artery disease (HR, 1.28), myocardial infarction (HR, 1.33), and death (HR, 5.80; P < .05 for all).
• Tertiary syphilis was significantly associated with increased risks for mortality (HR, 6.93), aortic aneurysm or dissection (HR, 5.57), ischemic stroke (HR, 3.23), hemorrhagic stroke (HR, 2.62), myocardial infarction (HR, 2.15), peripheral artery disease (HR, 2.45), heart failure (HR, 2.01), and atrial fibrillation (HR, 2.19; P < .05 for all).
• Late latent syphilis was associated with increased risks for mortality (HR, 4.08), aortic aneurysm or dissection (HR, 2.41), and ischemic stroke (HR, 1.82; P ≤ .001 for all). Primary or secondary syphilis showed no associations with cardiovascular outcomes.
• Syphilis was not significantly associated with the risk for heart failure, atrial fibrillation, aortic regurgitation, or venous thromboembolism.

IN PRACTICE:

“Given the rising incidence of syphilis both locally and nationally, these findings underscore the importance of early detection and treatment. Further research is needed to understand whether prompt antibiotic therapy mitigates long-term cardiovascular risk and to identify the best screening practices in patients most vulnerable to cardiovascular complications,” the researchers of the study wrote.

SOURCE:

The study was led by Eli Tsakiris, Tulane Research Innovation for Arrhythmia Discovery, New Orleans, Louisiana. It was published online on April 13 in JAMA Network Open.

LIMITATIONS:

The retrospective study design precluded drawing a causal inference. Unmeasured confounding variables such as smoking status, race, and ethnicity were not included in the analysis, which may have influenced the results. The control group may have included resolved syphilis cases, and recorded diagnoses of syphilis may have missed undiagnosed or previously treated infections not captured in structured health records.

DISCLOSURES:

No funding information was provided for this study. Some authors disclosed receiving grants and personal fees, holding equity, and serving on advisory boards for industry outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.