The Risk of Major Adverse Cardiovascular Events in Ankylosing Spondylitis Patients With a History of Acute Anterior Uveitis: A Nationwide, Population Based Cohort Study

Bai, Yi-Chiao; Liu, Chin‐Hsiu; Leong, Pui‐Ying; Lai, Kuo-Lung; Chen, Hsin‐Hua; Wei, James Cheng‐Chung

doi:10.3389/fmed.2022.884800

Cited by 5 publications

(9 citation statements)

References 31 publications

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“…To identify the potential origin of heterogeneity, leave-one-out sensitivity analysis was conducted. Of these three cohort studies, Bai et al [ 27 ], included AS patients with a history of AAU, whereas the other two studies (Feng et al [ 28 ], and Lai et al [ 29 ]) included AS patients with current combined uveitis. However, excluding Bai et al [ 27 ]., did not change the significant difference, but reduced the individual heterogeneity (HR = 1.66, 95% CI = 1.52–1.82, p < 0.00001; I 2 = 0%, p = 0.89) ( Figure S1 ), suggesting that significant heterogeneity was caused by the differences in recency of uveitis.…”

Section: Resultsmentioning

confidence: 99%

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Association Between Atherosclerosis-Related Cardiovascular Disease and Uveitis: A Systematic Review and Meta-Analysis

Gao

et al. 2022

Diagnostics

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Background: Uveitis is not only an intraocular inflammatory disease, but also an indicator of systemic inflammation. It is unclear whether uveitis can increase the risk of cardiovascular disease (CVD) through the atherosclerotic pathway. Methods: PubMed and Embase databases were searched until 5 September, 2022. Original studies investigating uveitis and cardiovascular events were selected. The random-effects model was used to calculate the difference of groups in pooled estimates. Results: A total of six observational studies that included mainly ankylosing spondylitis (AS) patients were included. Of these, three studies reported data on carotid plaques and carotid intima-media thickness (cIMT) and the other three studies provided data on atherosclerosis-related CVD. No significant difference was found in cIMT between uveitis and controls (MD = 0.01, 95% CI = −0.03–0.04, p = 0.66), consistent with the findings of carotid plaque incidence (OR = 1.30, 95% CI = 0.71–2.41, p = 0.39). However, uveitis was associated with a 1.49-fold increase in atherosclerosis-related CVD (HR = 1.49, 95% CI = 1.20–1.84, p = 0.0002). Conclusions: Uveitis is a predictor of atherosclerosis-related CVD in AS patients. For autoimmune disease patients with uveitis, earlier screening of cardiovascular risk factors and the implementation of corresponding prevention strategies may be associated with a better prognosis.

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Section: Resultsmentioning

confidence: 99%

“… ( A ) Forest plots showing pooled HR with 95% CI of atherosclerosis-related CVD for patients with uveitis versus those without. ( B ) Forest plots showing subgroup uveitis and atherosclerosis-related CVD [ 27 , 28 , 29 ]. …”

Section: Figurementioning

confidence: 99%

Association Between Atherosclerosis-Related Cardiovascular Disease and Uveitis: A Systematic Review and Meta-Analysis

Gao

et al. 2022

Diagnostics

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“…For example, some studies enrolled patients with at least two outpatient visits or one inpatient diagnosis, while others did not include inpatient records as part of their algorithm and only enrolled patients with records of outpatient visits. 8,29 Consequently, examinations of ICD-9/ICD-10 codes also play a crucial role in rheumatologic diseases. A study in the U.S. has also demonstrated that the selection of at least two ICD-10 diagnosis codes (M05 and M06) for rheumatoid arthritis (RA), along with at least one instance of dispensing RA treatments, could provide a more accurate definition of RA.…”

Section: Discussionmentioning

confidence: 99%

“…However, in other studies utilizing the same nationwide database, they adopted different definitions. For example, some studies enrolled patients with at least two outpatient visits or one inpatient diagnosis, while others did not include inpatient records as part of their algorithm and only enrolled patients with records of outpatient visits 8,29 . Consequently, examinations of ICD‐9/ICD‐10 codes also play a crucial role in rheumatologic diseases.…”

Section: Discussionmentioning

confidence: 99%

Validation of diagnosis algorithms for ankylosing spondylitis in claim‐based database

Gau,

Tsai,

Wang

et al. 2024

Int J of Rheum Dis

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BackgroundClaims‐based algorithms using International Classification of Diseases (ICD) codes have become a common approach for researchers to define ankylosing spondylitis (AS) in studies. To address potential misclassification bias caused by the claim‐based algorithms, we conducted the current study to validate whether these algorithms of medical claims could accurately represent AS diagnoses.MethodsPatients diagnosed with AS based on ICD codes were retrieved from the electronic medical records database at a Taiwanese medical center (Chung Shan University Hospital, Taiwan). After random sampling and stratification based on age and sex, the medical information of participants was appraised based on the 2009 ASAS guideline to evaluate the actual status of ICD codes claim‐based AS patients. Positive predict values (PPV) of different algorithms of ICD codes were also calculated.ResultsWithin the 4160 patients with claim‐based AS diagnosis, 387 eligible patients were finally included in the study design after random sampling. The PPV of the diagnostic algorithm of having at least 4 outpatient or 1 inpatient ICD record was 72.77 (95% CI, 66.79–78.75), whereas the PPV increased to 85.64 when the diagnoses were restricted to be made by rheumatologists (95% CI, 80.53–90.74).ConclusionsWhile performing database studies, researchers should be aware of the low PPV of specific algorithms when defining AS. Algorithms with higher PPV were recommended to be adopted to avoid misclassification biases.

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“…AS has an increased risk of developing chronic diseases such as diabetes mellitus and cardiovascular and cerebrovascular diseases ( 43 ). However, AS patients with acute anterior uveitis (AAU) did not increase the risk of subsequent major adverse cardiovascular events compared to non-AAU controls ( 44 ). The mechanism of how AS modifies glaucoma risk remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Ankylosing spondylitis and glaucoma in European population: A Mendelian randomization study

Chen

Zhang

et al. 2023

Front. Immunol.

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BackgroundThe relationship between ankylosing spondylitis (AS) and glaucoma in the European population remains unclear. In the present study, we applied a two-sample Mendelian randomization (MR) method to investigate their causal relationship.MethodsMR analysis was conducted to validate the causal associations between AS with glaucoma using summary statistics from the genome-wide association studies of AS (9,069 cases and 13,578 control subjects) and glaucoma (8,591 cases and 210,201 control subjects). The inverse variance weighting method was performed to evaluate the causal relationship. The MR–Egger regression approach was applied to assess pleiotropy, while Cochran’s Q test was used to analyze heterogeneity. Subgroup analysis was performed according to primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).ResultsThe results of the MR study reveal a risk-increasing causal relationship between AS and glaucoma among European populations (OR = 1.35, 95%CI = 1.16–1.57, P = 8.81 × 10-5). Pleiotropy and heterogeneity were not found in our study. In the subgroup analysis, AS was also causal with POAG (OR = 1.48, 95%CI = 1.17–1.86, P = 8.80 × 10-4) and PACG (OR = 1.91, 95%CI = 1.03–3.51, P = 3.88 × 10-2).ConclusionThe results of the MR analysis suggested a causal relationship between AS and glaucoma in the European population. Further studies are needed to identify the specific mechanism between these two diseases.

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The Risk of Major Adverse Cardiovascular Events in Ankylosing Spondylitis Patients With a History of Acute Anterior Uveitis: A Nationwide, Population Based Cohort Study

Cited by 5 publications

References 31 publications

Association Between Atherosclerosis-Related Cardiovascular Disease and Uveitis: A Systematic Review and Meta-Analysis

Association Between Atherosclerosis-Related Cardiovascular Disease and Uveitis: A Systematic Review and Meta-Analysis

Validation of diagnosis algorithms for ankylosing spondylitis in claim‐based database

Ankylosing spondylitis and glaucoma in European population: A Mendelian randomization study

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