Background/Purpose: There is evidence that shows an increased cardiovascular risk in patients with Axial Spondyloarthritis (axSpA). Ultrasonography (US) is a simple imaging tool used to assess cardiovascular risk by the detection of atherosclerotic lesions. Objectives: To evaluate the association between the cardiovascular (CV) risk estimated by a traditional score and the prevalence of subclinical atheromatosis detected by carotid US in patients with axSpA

Methods: A cross-sectional study was designed including consecutive patients with a diagnosis of axSpA (ASAS 2009 Criteria) without previous history of CV events. Patient´s demographic and disease characteristics were recorded. The presence and history of traditional CV risk factors were evaluated. The cardiovascular risk was stratified according to the Framingham score [percentaje of risk of presenting a 10-year cardiovascular event]. All patients underwent bilateral US carotid artery examination (common and internal carotid) to assess subclinical atherosclerosis. The presence of intima-media thickness (IMT) >0.9 mm and/or carotid plaques was used to define carotid atherosclerosis (US Carotid Atherosclerosis=USCA) as a marker of high cardiovascular risk. The association between clinical characteristics and US findings was assessed by univariate and multivariate analysis. ROC curves were developed to estimate cut-off values.

Results: Fifty-one patients with axSpA were included. The mean age was 43 ± 13 years, and 75% were men. The median disease duration was 12 years (IQR: 6-23), and the mean BASFI and BASDAI were 3.8 ± 2.9 and 3.9 ± 2.6, respectively. Sixty-five percent were receiving NSAIDs and 51% biological treatment. Eleven patients (22%) had hypertension, 13 (25%) dyslipidemia, and 9 (18%) were smokers. The mean score of the Framingham index was 8.6 ± 1.3. The patients were stratified in: low risk: 34 (67%), moderate risk: 12 (23%) and high risk: 5 (10%). The US evaluation detected the presence of USCA (plaque and / or IMT> 0.90 mm) in 21 (41%) patients, presence of plaques in 19 (37%), and IMT> 0.9 mm in 13 (25%). The frequency of USCA found in patients stratified by the different Framingham categories were: low risk: 6/34 (18%); moderate risk: 10/12 (83%); high risk: 5/5 (100%). In the univariate analysis the presence of USCA was more frequent in older patients (p <0.0001), longer disease duration (p = 0.008), hypertension (p = 0.001), dyslipidemia (p = 0.008) and higher BMI (p = 0.02) After adjusting for multiple confounding factors, age was the only variable associated with the presence of USCA. In the ROC analysis, the optimal cut-off value for age to predict the presence of USCA was 42.5 years, with a sensitivity and specificity of 85% and 82%, respectively (AUC: 0.90). The USCA prevalence was 82% (n = 18) in patients with age ≥42.5 years, compared to only 10% (n = 3) in those with age <42.5 years.

Conclusion: Subclinical atherosclerosis detected by US was found in a significant proportion (35%) of patients classified in low to moderate risk by the Framingham score. The majority of patients over 42.5 years of age presented high risk US lesions, and may require intensive CV risk management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-atheromatosis-and-estimation-of-cardiovascular-risk-in-patients-with-axial-spondyloarthritis/