ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 578

Female Patients but Not Male Patients with Ankylosing Spondylitis Are at Increased Risk of Developing Ischemic Heart Disease: A Population-Based Cohort Study

Ivette Essers1,2, Carmen Stolwijk1,2, Annelies Boonen3,4, Marie L. De Bruin5, Marloes Bazelier5, Frank de Vries5,6,7,8 and Astrid Van Tubergen1,2, 1School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands, 2Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands, 3Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands, 4Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, Netherlands, 5Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands, 6Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, Netherlands, 7MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, United Kingdom, 8Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Spondyloarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment I

Session Type: Abstract Submissions (ACR)

Background/Purpose:

It is well recognized that rheumatoid arthritis is an independent risk factor for cardiovascular disease. For ankylosing spondylitis (AS), the literature on this risk is relatively scarce, and shows conflicting results. Furthermore, these studies did not explore the role of non-steroidal anti-inflammatory drugs (NSAIDs) use on this risk. Therefore, the aim of the present study was to investigate the incidence and risk of ischemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of NSAIDs, in patients with AS compared with matched population controls.

Methods: All patients with newly diagnosed AS from the British Clinical Practice Research Datalink (1987-2012) were matched with up to 7 persons without AS by year of birth, gender and practice. Incidence rate ratios (IRRs) and hazard ratios (HR) for development of IHD and AMI were calculated. Stepwise analyses were performed adjusting for age, gender, comorbidity, and drug use, including NSAIDs.

Results:

In total, 3,809 patients with AS were matched with 26,196 population-based controls. The number of men (70.5% vs 70.7%), and the mean age (43.7 years vs. 43.3 years) were comparable for patients with AS and controls. The mean duration of follow up for patients and controls was 6.6 years. At baseline, 4.3% of the patients had a history of IHD, and 1.8% had a history of AMI, compared with 3.4% and 1.4% of the controls, respectively (p<0.01 and p=0.02, respectively). After excluding subjects with pre-existing cardiovascular disease, the overall IRR for IHD was 1.18 (95%-confidence interval [CI] 0.96-1.46) and for AMI 0.91 (95%-CI 0.65-1.27). Compared with controls, the age-gender adjusted HR for developing IHD was 1.20 (95%-CI 0.97-1.48), and for AMI 0.91 (95%-CI 0.65-1.28) for patients with AS. In female patients, the increased risk of developing IHD was statistically significant (HR 1.81, 95%-CI 1.18-2.79), but after adjustment for all possible risk factors only a non-significant trend towards increased risk was found (HR 1.36, 95%-CI 0.86-2.14). In particular, recent NSAID use explained the change in risk (female HR IHD adjusted for age-gender-NSAID use 1.47, 95%-CI 0.93-1.36). After stratification for the use of NSAIDs, the overall risk of IHD in patients with AS was 1.36-fold (95%-CI 1.00-1.87) increased with recent use of NSAIDs. This was particularly increased in female patients (HR fully adjusted 2.52, 95%-CI 1.41-4.51), but not in male patients (HR fully adjusted 1.13, 95%-CI 0.78-1.64). 

Conclusion: Female patients with AS are at increased risk of developing IHD, but this effect is associated with recent NSAID use. However, it cannot be excluded that NSAID use is (partly) a reflection of active disease.

Disclosure:

I. Essers,
None;

C. Stolwijk,
None;

A. Boonen,
None;

M. L. De Bruin,
None;

M. Bazelier,
None;

F. de Vries,
None;

A. Van Tubergen,
None.

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/female-patients-but-not-male-patients-with-ankylosing-spondylitis-are-at-increased-risk-of-developing-ischemic-heart-disease-a-population-based-cohort-study/