Background/Purpose: There is conflicting data on the risk of myocardial infarction (MI) and cerebrovascular accidents (CVA) in patients with Ankylosing Spondylitis (AS). This study attempts to assess the future risk of newly recorded MI and CVA events among incident cases of AS compared to non-AS controls from the general population by utilizing physician billing, medication, and hospitalization data that covers the entire province of British Columbia (BC), Canada.

Methods: Our data includes all outpatient visits and hospitalizations (1990-2012) and all dispensed medications (1996-2012) for all BC residents. We conducted a retrospective matched cohort study of all patients > 18 years of age satisfying the following criteria: 1) two ICD-9 or 10 codes (720.0 or M45) for AS at least two months apart and within a 2-year period by any physician or hospitalization; 2) all AS cases had at least a 7-year run-in period before the 1st ICD code for AS in order to consider the case as incident. Each AS patient was matched with up to 10 controls by birth year, sex, and entry cohort time. The outcomes were a newly recorded MI (ICD-9-CM: 410 or ICD-10-CM: I21) or CVA (ICD-9 codes: 433-434, ICD-10 codes: I63-I66) event from hospital or death certificates. We estimated relative risks (RRs), adjusting for age, sex, and entry cohort time as well as multivariable models adjusting for confounders including glucocorticoids and non-steroidal anti-inflammatory drugs using a Cox proportional hazard model.

Results: 7,190 individuals with newly diagnosed AS were identified (48.7% female, mean age of 45.8 yrs). 7,148 and 7,107 were free of previous CVA/MI, respectively. 80 developed CVA (incidence rate= 1.8 per 1000 patient years) and 115 had MI (incidence rate= 2.6 per 1,000 patient years) (Table 1). The age-, sex-, and entry-time-matched RR for CVA was 1.60 (95% CI, 1.25-2.03) and MI was 1.52 (95% CI, 1.24-1.85). When adjusted for cardiovascular risk factors (obesity, angina, COPD, hospitalizations in year before index date, Charlson’s comorbidity index, oral glucocorticoids, cardiovascular drugs, anti-diabetic medication, HRT, contraceptives, fibrates, statins, NSAIDs, and Cox-2 inhibitors), the estimated RR was 1.34 (1.04-1.73) for CVA and 1.21 (0.98-1.49) for MI.

Conclusion: This large population-based study demonstrates an increased risk of CVA, but not for MI. These findings support that increased monitoring for this potentially fatal outcome and its modifiable risk factors is warranted for AS patients.

Table 1: Relative risk of incident CVA and MI according to AS status

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-myocardial-infarction-and-cerebrovascular-accident-in-ankylosing-spondylitis-a-general-population-based-study/