Background/Purpose:

Patients with Ankylosing Spondylitis (AS) have previously
been considered an otherwise healthy patient population. However, emerging
evidence suggests AS is an independent risk factor for developing
cardiovascular (CV) disease. Due to the predominantly young age of AS patients,
screening for other traditional CV risk factors is often not performed. The AS Registry of Ireland (ASRI) was
established in 2013. The objectives of ASRI are to provide descriptive
epidemiological data on the AS population in Ireland and to establish a
registry for potential future studies of genetics, aetiology and therapeutics.
The purpose of this study was to evaluate the prevalence of traditional CV risk
factors in a well characterised AS patient cohort.

Methods:

A standardised detailed clinical assessment is performed on
each patient and entered in a web-based database. Disease activity is assessed
by Bath AS Disease Activity Index (BASDAI), function by the Bath AS Functional
Index (BASFI) and Health Assessment Questionnaire (HAQ) and quality of life by
AS Quality of Life (ASQoL). Structured interviews provide patient-reported
data, which include the presence of traditional CV risk factors, other
comorbidities and employment status. Statistical analysis is performed using
SPSS.

Results:

As of June 2015, 340 patients are enrolled in ASRI: 79.7%
males, mean age 47.6 (SD 12.6). The mean disease duration is 21.6 years (SD 12),
with an average delay to diagnosis of 8.9 years (SD 8.5). Mean BASDAI is 3.9
(SD 2.4), BASFI 3.8 (SD 2.6), HAQ 0.56 (SD 0.52) and ASQoL 6.27 (SD 5.4). 46.5%
of the cohort is engaged in full-time employment. 44.2% of those who are unemployed
or in part-time employment only, cite AS as the causative reason. Co-morbidities
are listed in table 1, the most prevalent being hypertension (25.9%),
hyperlipidaemia (20.9%), smoking (current smoker 27.4%; ex-smoker 32.1%) and
depression (13.5%). Patients are significantly more likely to have a higher
BASDAI if they are a smoker (p<0.05) or have depression (P<0.001), with a
trend towards higher disease activity in those with hypertension (p=0.06).
Higher BASFI scores are associated with hypertension, osteoporosis, diabetes and
hyperlipidaemia (p<0.05). Peptic ulcer disease is associated with a trend
towards higher BASDAI (p=0.09) and BASFI (p=0.05).

Conclusion:

Despite their relatively young age, there is a high
prevalence of traditional CV risk factors in this patient cohort, in particular
hypertension, hyperlipidaemia and smoking. The presence of co-morbidities is
associated with higher disease activity and functional impairment in this
patient cohort. With increasing focus on AS as an independent risk factor for
CV disease, quality improvement initiatives are needed to improve the
recognition of traditional CV risk factors among AS patients.

Table 1: Prevalence of
comorbidities