Session Type: Abstract Submissions (ACR)
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.
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.
M. L. De Bruin,
F. de Vries,
A. Van Tubergen,
« 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/