Assessment of subclinical atherosclerotic cardiovascular disease in patients with ankylosing spondylitis

Abstract

Objective: The aim of the present study was to compare patients with ankylosing spondylitis (AS) with healthy controls with respect to subclinical atherosclerotic cardiovascular disease (CVD). Methods: A total of 44 patients with AS with no history of CVD, diabetes mellitus, hypertension, chronic kidney disease, and lipid-lowering drug use were compared with 40 age-and sex-matched healthy controls with respect to carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), which are surrogate markers of subclinical atherosclerosis. Correlation analysis was also performed to examine the association between surrogate markers and disease activity with inflammation [Ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP)]. Results: In addition to age and sex, both groups were comparable with respect to cigarette smoking, body mass index, and high-density lipoprotein cholesterol (p=0.425, p=0.325, and p=0.103, respectively). The level of total cholesterol was significantly lower in patients with AS (p=0.002). Nonsteroidal anti-inflammatory drug and tumor necrosis factor alpha inhibitor use ratios in patients with AS were 79.5% and 65.9%, respectively. There was no significant difference between both groups regarding PWV and CIMT (p=0.788 and p=0.253, respectively). In patients with AS, there was a significant correlation between ASDAS-CRP and CIMT (r=0.315, p=0.038), but the correlation between ASDAS-CRP and PWV was not significant (r=−0.183, p=0.234). Conclusion:The results of the present study could not provide sufficient evidence whether disease activity with inflammation caused subclinical atherosclerotic CVD in patients with AS without overt CVD. The increased atherosclerotic CVD risk is most probably multifactorial in patients with AS, but the extent of the contribution of disease activity with inflammation to increased atherosclerosis is controversial. (Anatol J Cardiol 2019; 22: 185-91) ABSTRACT Hatipsoylu et al.

Unexpected increase of aortic stiffness in juvenile Spondyloarthropathies

“…Aortic stiffness was also high in this group, suggests that an increase in stiffness is associated with the inflammatory process. 27 In our study, we found a similar relation with disease activity and strain. Aortic root strain was lower in juvenile spondyloarthropathy patients with high juvenile ankylosing spondylitis disease activity index scores.…”

“…26 In another study, a positive relationship was found between arterial stiffness, disease activity and loss of function. 27 The authors demonstrated that erythrocyte sedimentation rate and C-reactive protein were mostly high in ankylosing spondylitis patients on conventional disease-modifying anti-rheumatic drugs. Aortic stiffness was also high in this group, suggests that an increase in stiffness is associated with the inflammatory process.…”

Subclinical atherosclerosis: A hidden threat for patients with ankylosing spondylitis

“…A recently published study reported a rapid and sustained reduction of complement activation in patients with spondyloarthritis patients using TNF inhibitors and suggested that the observed decrease in cardiovascular morbidity is partly owing to its beneficial effect on complement (9). Nevertheless, the duration of the use of the TNF inhibitors was not reported in this study, and we can suggest that a multivariate analysis of the study data will confirm this protective effect of TNF therapy (1).…”

“…In the current study entitled "Assessment of subclinical atherosclerotic cardiovascular disease in patients with ankylosing spondylitis" Anatol J Cardiol 2019; 22: 185-91, Hatipsoylu et al (1), authors have failed to demonstrate the relationship between AS and atherosclerosis progression. Nevertheless, it was a study in which some main traditional risk factors for CVD were controlled.…”

Endothelial dysfunction and increased carotid intima–media thickness in patients with spondyloarthritis without traditional cardiovascular risk factors

“… 1 2 However, this hypothesis remains controversial in other series which have shown the absence of an increase in atherosclerosis markers in patients with SpA compared with controls. 3 4 To date, the mechanisms and mediators of accelerated atherosclerosis in SpA are not as clear as in rheumatoid arthritis. This would result from a complex interaction between the over-representation of traditional CV risk factors in patients with SpA and the inflammatory burden of the disease.…”