Session Information
Date: Sunday, November 8, 2015
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: It is unclear whether and to what extent different phenotypes of spondylarthritis (SpA) are associated with an increased risk of cardiovascular events such as acute coronary syndrome (ACS), stroke and venous thromboembolism (VTE). Studies have indicated that ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are associated with an increased risk of cardiovascular morbidity, but the results have been divergent and for undifferentiated spondylarthritis (uSpA) it has not been studied. Our objective was to investigate the incidence and risk of these cardiovascular outcomes in patients with AS, PsA and uSpA compared to each other and to general population (GP) comparators.
Methods: The study design was a prospective nationwide population-based cohort study, including an AS cohort (n=6228), a PsA cohort (n=16039), an uSpA cohort (n=4795) and a GP cohort (n=269815). The cohorts were identified between 2001 and 2009 in the Swedish Patient and Population registers. Patients with diagnoses for more than one SpA phenotype (n=1943) were excluded. The follow-up began January 1, 2004 or at the date of first diagnosis thereafter in previously undiagnosed cases and extended until the first outcome occurrence, death, emigration or December 31, 2012, whichever occurred first. Subjects with a history of each of the cardiovascular outcomes of interest were excluded from the analysis of that outcome. Number of outcomes, person-years at risk, crude rates and age- and sexstandardized rates to the GP cohort were calculated for each outcome and cohort. Age- and sexadjusted hazard ratios (HRs) were calculated using Cox proportional hazard regression analysis.
Results: Age-and sexadjusted HRs for ACS and stroke events were significantly increased in PsA (HR (95% CI) 1.71 (1.56-1.88) and 1.41 (1.29-1.54)) and in AS (HR 1.47 (1.26-1.73) and 1.33 (1.14-1.55)), and non-significantly increased in uSpA compared to the GP cohort. For VTE the age-and sexadjusted HRs for both AS, PsA and uSpA were equally and significantly increased with about 50% compared to the GP cohort. Patients with uSpA had a significantly lower HR for ACS than patients with PsA, otherwise no significant differences in HRs were noted between the SpA phenotypes (Table).
|
|
AS |
PsA |
uSpA |
GP |
|
Acute coronary syndrome |
|
|
|
|
|
Subjects at risk, n |
5987 |
15516 |
4707 |
262002 |
|
Incident events, n |
161 |
481 |
62 |
7144 |
|
Crude rates |
4.0 (3.4-4.6) |
4.8 (4.3-5.2) |
2.0 (1.5-2.5) |
3.2 (3.2-3.3) |
|
Standardized rates* |
4.1 (3.3-4.9) |
5.4 (4.9-5.9) |
4.3 (2.9-5.7) |
na |
|
Hazard ratio† (GP as ref.) |
1.47 (1.26-1.73) |
1.71 (1.56-1.88) |
1.26 (0.98-1.62) |
1 |
|
Hazard ratio† (PsA as ref.) |
0.86 (0.72-1.03) |
1 |
0.75 (0.57-0.98) |
na |
|
Stroke |
|
|
|
|
|
Subjects at risk, n |
6051 |
15576 |
4726 |
261953 |
|
Incident events, n |
172 |
532 |
74 |
9877 |
|
Crude rates |
4.2 (3.6-4.9) |
5.3 (4.8-5.7) |
2.4 (1.9-3.0) |
4.5 (4.4-4.6) |
|
Standardized rates* |
5.5 (4.4-6.6) |
5.9 (5.4-6.4) |
5.6 (3.9-7.2) |
na |
|
Hazard ratio† (GP as ref.) |
1.33 (1.14-1.55) |
1.41 (1.29-1.54) |
1.22 (0.97-1.53) |
1 |
|
Hazard ratio† (PsA as ref.) |
0.97 (0.81-1.16) |
1 |
0.90 (0.70-1.15) |
na |
|
Venous thromboembolism |
|
|
|
|
|
Subjects at risk, n |
6124 |
15705 |
4721 |
266418 |
|
Incident events, n |
105 |
289 |
56 |
4762 |
|
Crude rates |
2.5 (2.1-3.0) |
2.8(2.5-3.1) |
1.8 (1.4-2.3) |
2.1 (2.1-2.2) |
|
Standardized rates* |
3.3 (2.4-4.1) |
3.0 (2.6-3.4) |
3.1 (2.1-4.2) |
na |
|
Hazard ratio† (GP as ref.) |
1.52 (1.25-1.84) |
1.48 (1.31-1.67) |
1.49 (1.14-1.94) |
1 |
|
Hazard ratio† (PsA as ref.) |
1.13 (0.90-1.43) |
1 |
1.01 (0.75-1.35) |
na |
Rates are presented as number of events/1000 person-years. All rates and hazard ratios are calculated with 95 % confidence interval given in parenthesis. *Age- and sexadjusted with the GP cohort as reference. †Age- and sexadjusted.
Conclusion:
We found that patients with AS or PsA had a significantly higher risk of having a first event of ACS and stroke compared to GP comparators. Both AS, PsA and uSpA patients had a nearly 50% increased risk of experiencing a first event of VTE compared to the GP. There were no significant differences between the SpA phenotypes, except for a lower risk for ACS in uSpA patients compared to PsA patients.
To cite this abstract in AMA style:
Bengtsson K, Forsblad-d'Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S, Lindström U, Askling J, Jacobsson LT. Are Ankylosing Spondylitis, Psoriatic Arthritis and Undifferentiated Spondylarthritis Associated with an Increased Risk of Cardiovascular Disease? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/are-ankylosing-spondylitis-psoriatic-arthritis-and-undifferentiated-spondylarthritis-associated-with-an-increased-risk-of-cardiovascular-disease/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-ankylosing-spondylitis-psoriatic-arthritis-and-undifferentiated-spondylarthritis-associated-with-an-increased-risk-of-cardiovascular-disease/