Background/Purpose: Ankylosing Spondylitis (AS) is associated with an increased risk of cardiovascular disease, partly due to systemic inflammation, and an increased risk of vascular mortality. Since the late 1990s, biologic and targeted therapies have improved outcomes in immune-mediated inflammatory diseases. We sought to investigate cardiovascular mortality trends in AS in the USA in the era of biologic therapies.

Methods: This retrospective cohort study used the Multiple Cause of Death files maintained by the National Center for Health Statistics. The data set contains death certificates for US residents, in which the underlying cause of death is ascertained by the treating physician in the section on the cause of death on the certificate. Each certificate identifies demographic information, a single underlying cause of death, and up to 20 additional contributory causes of death. We investigated temporal trends of proportionate cardiovascular mortality, defined as the number of cardiovascular deaths (the underlying cause of death: International Classification of Diseases, version 10 [ICD10]: I00-I99), divided by the number of all-cause mortality, in patients with AS (defined in multiple causes of death: ICD10 code M45) between 1999 and 2020. Spearman’s correlation test was used for trend analysis, and the Chi-square test was used for comparisons.

Results: 4,405 deaths in subjects with AS occurred during the study period, with an age-adjusted mortality rate of 7 per 10 million people. Overall, 984 (22%) died of cardiovascular causes. The mean age of cardiovascular mortality was 73 years. The proportionate cardiovascular mortality decreased from 34% in 1999 to 21% in 2020 (trend P< 0.001), Figure 1. Proportionate cardiovascular mortality was similar in men and women (23% vs. 20%, P=0.08) and in Black and White individuals (25% vs. 22%, P=0.47). The most common cardiovascular causes were ischemic heart disease (51%), hypertension and its sequelae (12%), heart failure (7%), stroke (5%), arrhythmia (4%), aortic valve disease (3%), and others (16%).

Conclusion: This national study of death certificate data showed a significant reduction in proportionate cardiovascular mortality in AS in the USA in the era of biologic and targeted therapies. Mechanistic prospective cohort studies are needed to understand the impact of biological therapies on cardiovascular risk in AS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/trends-in-proportionate-cardiovascular-mortality-in-patients-with-ankylosing-spondylitis-in-the-era-of-biologic-therapies-analysis-of-us-death-certificate-data/