Disease Activity in Ankylosing Spondylitis and Associations to Markers of Vascular Pathology and Traditional Cardiovascular Disease Risk Factors: A Cross-sectional Study

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Figure 1.
Markers of vascular pathology in patients with ankylosing spondylitis (AS) who have high and low ASDAS, and controls. Linear regression models presented with estimated marginal means and 95% CI. ^aAdjusted for age, sex, BMI, current smoking, and creatinine. ^bAdjusted for age, sex, BMI, current smoking, CMAP, and height. ^cAdjusted for age, sex, BMI, current smoking, and CMAP. ASDAS: AS Disease Activity Score; ADMA: asymmetric dimethylarginine; BMI: body mass index; CMAP: central mean arterial pressure.
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Figure 2.
Traditional cardiovascular risk factors in patients with ankylosing spondylitis (AS) who have high and low ASDAS, and controls. Linear regression models presented with estimated marginal means and 95% CI. ^aAdjusted for age, sex, BMI, current smoking, and use of statins. ^bAdjusted for age, sex, current smoking. ^cAdjusted for age, sex, BMI, current smoking, and use of antihypertensive. ^dAdjusted for age and sex, and presented with geometric mean; patients with CVD, diabetes, or outside the age range 40–65 years were excluded. ^eAdjusted for age and sex, and presented with geometric mean; patients with CVD or diabetes were excluded. ASDAS: AS Disease Activity Score; BMI: body mass index; BP: blood pressure; CVD: cardiovascular disease; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol.

Table 1.

Characteristics of patients with ankylosing spondylitis (AS) and controls.

Comparisons using bivariate tests as appropriate; Student t test for normally distributed data, Mann-Whitney U test for not normally distributed data, and chi-square test/Fisher’s test [when expected number was < 5 for at least 1 cell in ASDAS subgroups (diabetes and prednisolone)] for counts.
↵a p value < 0.05, AS, all versus controls.
↵b p value < 0.05, AS, ASDAS ≥ 2.1 versus controls.
↵c p value < 0.05, AS, ASDAS < 2.1 versus controls.
↵d p value < 0.05, AS, ASDAS ≥ 2.1 versus AS, ASDAS < 2.1. ASDAS: AS Disease Activity Score; BASDAI: Bath AS Disease Activity Index; CRP: C-reactive protein; CVD: cardiovascular disease; DMARD: disease-modifying antirheumatic drugs; ESR: erythrocyte sedimentation rate; NSAID: nonsteroidal antiinflammatory drugs; TNF-α: tumor necrosis factor-α; IQR: interquartile range.

Table 2.

Markers of vascular pathology and traditional cardiovascular risk factors in patients with ankylosing spondylitis (AS) and controls.

	AS EMM (SE)	Controls EMM (SE)	Mean Difference (95% CI)	p
Markers of vascular pathology
ADMA, µmol/l^a	0.54 (0.01)	0.49 (0.01)	0.05 (0.03, 0.07)	< 0.001
Ratio L-arginine/ADMA^a	107 (2)	117 (3)	−10 (−16, −4)	0.001
AIx, %^b	19.4 (0.7)	16.9 (0.7)	2.6 (0.8, 4.3)	0.01
PWV, m/s^c	7.49 (0.12)	7.55 (0.12)	−0.06 (−0.35, 0.24)	0.71
Traditional CVD risk factors
TC, mmol/l^d	5.07 (0.11)	5.31 (0.12)	−0.24 (−0.48, −0.01)	0.04
LDL-C, mmol/l^d	2.85 (0.10)	3.11 (0.11)	−0.26 (−0.47, −0.05)	0.02
HDL-C, mmol/l^d	1.53 (0.05)	1.56 (0.05)	−0.03 (−0.13, 0.07)	0.54
Ratio TC/HDL-C^d	3.59 (0.14)	3.65 (0.14)	−0.06 (−0.35, 0.23)	0.68
BMI, kg/m² ^{^e}	25.2 (0.3)	25.5 (0.3)	−0.3 (−1.2, 0.6)	0.48
Brachial SBP, mmHg^f	126 (2)	127 (2)	−1 (−5, 3)	0.68
CVD risk scores
InEuropean Heart Score (+0.5)^g	0.63 (0.05)	0.60 (0.05)	0.03 (−0.11, 0.17)	0.68
InFramingham Risk Score (+0.5)^h	1.88 (0.04)	1.89 (0.04)	−0.01 (−0.13, 0.10)	0.81
InReynolds Risk Score (+0.5)^h	1.01 (0.05)	0.96 (0.04)	0.05 (−0.07, 0.18)	0.42

Linear regression models presented with estimated marginal mean (EMM; SE) and estimated difference (95% CI).
↵a Adjusted for age, sex, BMI, current smoking, creatinine.
↵b Adjusted for age, sex, BMI, current smoking, CMAP, height.
↵c Adjusted for age, sex, BMI, current smoking, CMAP.
↵d Adjusted for age, sex, BMI, current smoking, use of statins.
↵e Adjusted for age, sex, current smoking.
↵f Adjusted for age, sex, BMI, current smoking, use of antihypertensive.
↵g Adjusted for age, sex, and presented with geometric mean; patients with CVD, diabetes, or outside the age range 40–65 years were excluded.
↵h Adjusted for age, sex, and presented with geometric mean; patients with CVD or diabetes were excluded. ADMA: asymmetric dimethylarginine; AIx: augmentation index; BMI: body mass index; CMAP: central mean arterial pressure; CVD: cardiovascular disease; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; PWV: pulse wave velocity; SBP: systolic blood pressure; TC: total cholesterol.