Background/Purpose: Patients with ankylosing spondylitis (AS) have a decreased life expectancy due to an increased cardiovascular (CV) risk. The general inflammatory process is held responsible together with an increased prevalence of traditional risk factors such as hypertension and hypercholesterolemia. We investigated the prevalence of these CV risk factors in AS patients and whether these are treated according to the present guidelines.

Methods: We evaluated CV risk factors in all patients (n=290) eligible for treatment with TNF inhibitors. All patients fulfilled the New York 1984 criteria for AS. Hypertension was defined as systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) >90 mmHg. Overweight was defined as body mass index (BMI) >25 kg/m². Hypercholesterolemia was defined as LDL> 2.5 mmol/L. The 10- year estimated cardiovascular risk was calculated with the Dutch multidisciplinary guideline for cardiovascular risk management. It is expressed as the risk percentage (%) for cardiovascular events in the next ten years.

Results: More than 40% of patients smoked at baseline compared to 27% in the general Dutch population. Overweight was present in 144 (50%) of patients compared to 26% in the general Dutch population. Of 187 patients the cardiovascular risk could be calculated. Hundred sixty-four patients (88%) had low cardiovascular risk (<10%). Twenty-three patients (12%) had a medium or high cardiovascular risk (>10%). Eleven of these patients (48%) were treated with either antihypertensive agents or statins. In addition, four patients had SBP >180 mmHg, of which two were on antihypertensive agents and four patients had a total cholesterol/HDL ratio of >8, of which one was treated with statins.

Fifty-one out of 270 patients (19%) were on antihypertensive medication on baseline, of which 15 (29.4%) were inadequately treated as they still had higher BPs than treatment targets. Twenty-six out of 270 patients (10%) were on statin treatment, of which 9 (35%) were inadequately treated as they still had higher LDL levels than recommended (>2.5 mmol/L).

Conclusion: One in five AS patients were treated for hypertension and one in ten for hypercholesterolemia. Of these patients approximately one third did not reach the treatment targets. Over half of AS patients with medium to high cardiovascular risk were not treated at all. Obviously, there is an impressive under treatment of cardiovascular risk factors in AS. Hence, more attention for screening as well as proper management of cardiovascular risk factors in patients with AS is urgently needed to lower the cardiovascular risk.   

Figure 1. Treatment of AS patients with antihypertensive medication.