Cardiovascular risk factors in patients with spondyloarthritis from Northern European and Mediterranean countries: An ancillary study of the ASAS-COMOSPA project

López-Medina, Clementina; Jiménez‐Gómez, Yolanda; Moltó, Anna; Schiotis, Ruxandra Elena; Marzo‐Ortega, Helena; Gaalen, F. van; Özgöçmen, Salih; Dougados, Maxime; Calvo‐Gutiérrez, Jerusalem; Castro-Villegas, M.C.; Estévez, E. Collantes; Font‐Ugalde, Pilar; force, Asas-Comospa task

doi:10.1016/j.jbspin.2017.07.006

Cited by 24 publications

(28 citation statements)

References 32 publications

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“…Obesity is not that frequent in pure axial forms of the disease ( 73 ). However, prevalence of obesity is increased in patients with peripheral forms of SpA (e.g., PsA) and has been reported to involve to 30% of patients with PsA.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Comorbidities in Spondyloarthritis

Moltó

Nikiphorou

2018

Front. Med.

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Comorbidities in spondyloarthritis (SpA) add to the burden of disease by contributing to disease activity, functional and work disability, and mortality. Thus, awareness of comorbidities in SpA is crucial to improve their screening and management and to ultimately improve outcomes in those affected. Osteoporosis has been reported to be the most prevalent comorbidity in SpA, and its risk is increased in these patients, compared with the general population; the risk of vertebral fractures requires further evaluation. Cardiovascular risk is also increased in this population, both due to an increase of the traditional cardiovascular risk factors in these patients, but also due to the presence of inflammation. The role of non-steroidal anti-inflammatory drugs in this increased risk needs further elucidation, but there is consensus on the need to encourage smoking cessation and to perform periodic evaluation of cardiovascular risk in these patients, particularly in the case of change in treatment course. Concerning the risk of cancer, no increased risk inherent to SpA seems to exist. However, an increased neoplastic risk can occur due to SpA treatments, e.g., P-UVA. Data are sparse on the risk of infections compared with rheumatoid arthritis, but there appears to be no risk in the absence of TNF-inhibitor exposure. Regardless of which comorbidity, a gap exists between recommendations for their management and actual implementation in clinical practice, suggesting that there is still a need for improvement in this area. Systematic screening for these comorbidities should improve both short- and long-term outcomes in SpA patients.

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Section: Cardiovascular Diseasementioning

confidence: 99%

Comorbidities in Spondyloarthritis

Moltó

Nikiphorou

2018

Front. Med.

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“…88 Although obesity is not that frequent in pure axial forms of spondyloarthritis (SpA), its prevalence is increased in patients with peripheral forms of SpA such as PsA. 89 Interestingly, higher BMI has been reported in PsA patients compared with healthy individuals and patients with psoriasis or RA. 7 A large UK study found that among psoriasis patients, PsA incidence rates increased with increasing BMI.…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

Inflammation, obesity and rheumatic disease: common mechanistic links. A narrative review

Nikiphorou

Fragoulis

2018

Therapeutic Advances in Musculoskeletal

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Obesity represents a rising global health concern, linked to significant social, psychological and physical burden to the individual affected, people around them and the society as a whole. Obesity has been described as a low-grade inflammatory condition, associated with increased production of pro-inflammatory mediators like tumor necrosis factor alpha or interleukin 6 and altered expression of adipokines. Adipokines, mainly produced by adipose tissue, have mixed pro- and anti-inflammatory properties. Obesity rarely exists on its own; instead, it tends to coexist with (often multiple) other comorbidities, including metabolic, cardiovascular, and rheumatic and musculoskeletal diseases (RMDs). In the case of RMDs, evidence is rapidly accumulating on common mechanistic pathways implicated in the inflammatory states seen between RMDs and obesity. Although there remain unanswered questions on the exact mechanisms of inflammation that link obesity to RMDs, what is becoming increasingly known is the association between obesity and adverse clinical outcomes in RMDs. This narrative review discusses insights into mechanisms of inflammation linking obesity and RMDs and evidence on the impact of obesity on treatment response and important disease outcomes. We highlight the importance of targeting obesity, a common and modifiable comorbidity, as part of the routine care of people with RMDs.

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“…However, most studies focused on the prevalence of hyperlipidemia in patients with axSpA and only a few compared a full lipid panel between patients and controls assessed in real-life clinical practice. In this regard, studies derived from the ASAS-COMOSPA cohort (28)(29)(30) defined the presence of dyslipidemia based on the presence of hypercholesterolemia or cholesterol-lowering therapy or on an LDL cholesterol level above target according to country recommendations. However, as neither a complete lipid profile was not assessed nor was a comparison with controls performed, no association analyses were carried out in a multivariate way.…”

Section: Discussionmentioning

confidence: 99%

Proprotein Convertase Subtilisin/Kexin Type 9 in the Inflammation-Related Dyslipidemia of Patients with Axial Spondyloarthritis is Related to Disease Activity.

Ld¹,

Quevedo-Abeledo²,

Ad³

et al. 2020

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Introduction: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease that regulates cholesterol metabolism through low-density lipoprotein receptor degradation and that has been linked to cardiovascular risk. The purpose of the present study was to examine whether PCSK9 levels are related to both abnormalities in the lipid profile and the development of severe atherosclerosis that often occurs in patients with axial spondyloarthritis (axSpA). Methods: Cross-sectional study that encompassed 545 individuals; 299 patients with axSpA and 246 statin use-matched controls. PCSK9, lipoproteins serum concentrations and standard lipid profiles were analyzed in patients and controls. Carotid intima-media thickness (cIMT) and carotid plaques were assessed in patients. A multivariable analysis, adjusted for standard cardiovascular risk factors, was performed to evaluate the influence of PCSK9 on axSpA related dyslipidemia and subclinical carotid atherosclerosis.Results: Most lipid panel parameters (total cholesterol, HDL- and LDL-cholesterol, lipoprotein (a) and apoliprotein A1) were significantly lower in axSpA patients than controls. PCSK9 serum levels (beta coef. -44 [95%CI -60- -27] ng/dl, p=0.000) were also downregulated in axSpA patients after fully multivariate adjustment, including other lipid profile-related molecules modifications that the disease generates. Unadjusted higher levels of PCSK9 were associated with carotid plaque in axSpA patients (beta coef. 27 [95%CI 9-45], p=0.003). ASDAS-CRP was found to be independently and significantly related to PCSK9 (beta coef. 10 [95%CI 1-18] ng/dl, p=0.023) after analyzing fully adjusted models that took age, sex, and the rest of lipid profile molecules into account. Whereas patients taking prednisone showed higher serum levels of PCSK9 (55 [95%CI 24-8]) ng/ml, p=0.001), those under anti-TNF alpha therapies exhibited lower levels (beta coef. -26 [95%CI -43- -9], p=0.003).Conclusion: PCSK9 is downregulated in patients with axSpA. Disease activity is positive and significantly related to PSCK9. Anti-TNF-therapy yields reduction in PCSK9 serum levels.

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Cardiovascular risk factors in patients with spondyloarthritis from Northern European and Mediterranean countries: An ancillary study of the ASAS-COMOSPA project

Abstract: Our results suggest that SpA phenotype and geographical area are associated with the prevalence of cardiovascular risk factors and the cardiovascular risk itself, observed in patients in the ASAS-COMOSPA cohort.

Cited by 24 publications

References 32 publications

Comorbidities in Spondyloarthritis

Comorbidities in Spondyloarthritis

Inflammation, obesity and rheumatic disease: common mechanistic links. A narrative review

Proprotein Convertase Subtilisin/Kexin Type 9 in the Inflammation-Related Dyslipidemia of Patients with Axial Spondyloarthritis is Related to Disease Activity.

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