Exploring Occupational, Recreational and Environmental Associations in Patients with Clinically Manifest Cardiac Sarcoidosis

ABSTRACT Background Sarcoidosis is a condition of unknown etiology. A number of occupational, recreational and environmental exposures have been associated with the development of extra-cardiac sarcoidosis. Patients with clinically manifest cardiac sarcoidosis (CS) have a distinct clinical phenotype. We sought to explore the exposures associated with clinically manifest CS. Methods Two groups of patients were recruited in a prospective registry. Cases Patients with clinically manifest CS. Controls Control group (patients without sarcoidosis and who had similar cardiac presentations to cases) A validated survey, previously used in other sarcoidosis phenotypes, was sent to all patients. Results A total of 113 patients met the inclusion criteria and were sent the survey of whom 79/113 (69.9%) completed the survey. We found three environmental associations. Firstly, a negative association with smoking, with 8/43 (18.6%) of CS patients being current or ex-smokers compared to 17/36 (47.2%) of the controls. Secondly, a positive association with mold exposure, with 21/43 (48.8%) CS patients having a prior history of mold exposure compared to 9/36 (25.0%) of the controls. After multi-variable analysis there remained significant associations between CS and smoking (OR, 0.14 (0.04-0.51), p=0.002) and mold exposure (OR, 5.69 (1.68-19.25), p=0.005). Finally, patients with CS and self-reported acne had a significantly longer duration of active acne (7.82±3.97 years) than control patients 2.67±1.03years (p= 0.006). Conclusions We found a negative association between smoking history and the diagnosis of CS. We also found a significant five-fold increase in mold exposure and a positive association with duration of acne in patients with CS compared to controls.