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Cardiovascular and Cerebrovascular Diseases in Ankylosing Spondylitis: Current Insights

  • SERONEGATIVE ARTHRITIS (MA KHAN, SECTION EDITOR)
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Abstract

Patients with ankylosing spondylitis (AS) suffer from an increased cardiovascular (CV) risk. The evidence for increased atherosclerotic disease is nowadays convincing, while the precise contribution of the so-called AS-specific (related) cardiac manifestations toward the increased CV risk still needs to be determined. Such studies should be performed in the near future, since they might have clinical consequences—for example, mandatory echocardiographic screening of AS patients. There appears to be a clear contribution of the “traditional” CV risk factors, as well as the underlying chronic inflammatory process, to the increased atherosclerotic risk in AS. Furthermore, there is accumulating evidence for an etiological role of inflammation in the AS-related cardiac manifestations. Nowadays, CV risk management appears necessary for AS patients, and this should consist of, on the one hand, assessment and treatment, if necessary, of the “traditional” CV risk factors, and, on the other hand, effective suppression of the inflammatory process.

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References

Papers of particular interest, published recently, have been highglighted as : • Of importance •• Of major importance

  1. Hahn BH, Grossman J, Chen W, McMahon M. The pathogenesis of atherosclerosis in autoimmune rheumatic diseases: roles of inflammation and dyslipidemia. J Autoimmun. 2007;28:69–75.

    Article  PubMed  CAS  Google Scholar 

  2. Bakland G, Gran JT, Nossent JC. Increased mortality in ankylosing spondylitis is related to disease activity. Ann Rheum Dis. 2011;70:1921–5.

    Article  PubMed  Google Scholar 

  3. Mok CC, Kwok CL, Ho LY, et al. Life expectancy, standardized mortality ratios, and causes of death in six rheumatic diseases in Hong Kong, China. Arthritis Rheum. 2011;63:1182–9.

    Article  PubMed  CAS  Google Scholar 

  4. Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, Nurmohamed MT. Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum. 2004;34:585–92.

    Article  PubMed  Google Scholar 

  5. Zochling J, Braun J. Mortality in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27 Suppl 55:S127–30.

    PubMed  CAS  Google Scholar 

  6. • Symmons DPM, Goodson NJ, Cook MN, Watson DJ. Men with ankylosing spondylitis have an increased risk of myocardial infarction. Arthritis Rheum. 2004;50(Suppl):S477. The first large-scale community-based study in AS. However, a full paper is not (yet) available.

    Google Scholar 

  7. Han C, Robinson DWJ, Hackett MV, et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2006;33:2167–72.

    PubMed  Google Scholar 

  8. •• Szabo SM, Levy AR, Rao SR, et al. Increased risk of cardiovascular and cerebrovascular disease in individuals with ankylosing spondylitis: A population-based study. Arthritis Rheum. 2011;63:3294–304. Largest well-documented population-based investigation clearly demonstrating increased hospitalisation rates in AS patients for various types of cardiovascular disease.

    Article  PubMed  Google Scholar 

  9. Peters MJ, Visman I, Nielen MM, et al. Ankylosing spondylitis; a risk factor for myocardial infarction? Ann Rheum Dis. 2010;69:579–81.

    Article  PubMed  CAS  Google Scholar 

  10. Bremander A, Petersson IF, Bergman S, Englund M. Population-based estimates of common comorbidities and cardiovascular disease in ankylosing spondylitis. Arthritis Care Res. 2011;63:550–6.

    Article  Google Scholar 

  11. O'Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14–22.

    Article  PubMed  Google Scholar 

  12. Mathieu S, Gossec L, Dougados M, Soubrier M. Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Care Res. 2011;63:557–63.

    Article  Google Scholar 

  13. Gonzalez-Juanatey C, Vazquez-Rodriguez TR, Miranda-Filloy JA, et al. The high prevalence of subclinical atherosclerosis in patients with ankylosing spondylitis without clinically evident cardiovascular disease. Medicine (Baltimore). 2009;88:358–65.

    Article  Google Scholar 

  14. Hamdi W, Chelli Bouaziz M, Zouch I, et al. Assessment of preclinical atherosclerosis in patients with ankylosing spondylitis. J Rheumatol. 2012;9:322–6.

    Article  Google Scholar 

  15. • Kerekes G, Soltész P, Nurmohamed MT, et al. Validated methods for assessment of subclinical atherosclerosis in rheumatology. Nat Rev Rheumatol. 2012;21:224–34. Comtemporary review addressing the most appropriate vascular function tests in currently applied rheumatology.

    Article  Google Scholar 

  16. Bodnár N, Kerekes G, Seres I, et al. Assessment of subclinical vascular disease associated with ankylosing spondylitis. J Rheumatol. 2011;38:723–9.

    Article  PubMed  Google Scholar 

  17. Lui NL, Thumboo J, Inman R. Cardiomyopathy in ankylosing spondylitis. Arthritis Care Res. 2011;63:564–9.

    Article  Google Scholar 

  18. Roldan CA. Valvular and coronary heart disease in systemic inflammatory diseases: systemic disorders in heart disease. Heart. 2008;94:1089–101.

    Article  PubMed  Google Scholar 

  19. Palazzi C, Salvarani C, D'Angelo S, Olivieri I. Aortitis and periaortitis in ankylosing spondylitis. Joint Bone Spine. 2011;78:451–5.

    Article  PubMed  Google Scholar 

  20. Yildirir A, Aksoyek S, Calguneri M, et al. Echocardiographic evidence of cardiac involvement in ankylosing spondylitis. Clin Rheumatol. 2002;21:129–34.

    Article  PubMed  CAS  Google Scholar 

  21. Lange U, Stapfer G, Ditting T, et al. Pathologic alterations of the heart and the kidney in patients with ankylosing spondylitis. Eur J Med Res. 2007;12:573–81.

    PubMed  CAS  Google Scholar 

  22. Brunner F, Kunz A, Weber U, Kissling R. Ankylosing spondylitis and heart abnormalities: do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population? Clin Rheumatol. 2006;25:24–9.

    Article  PubMed  Google Scholar 

  23. Park SH, Sohn IS, Joe BH, et al. Early cardiac valvular changes in ankylosing spondylitis: a transesophageal echocardiography study. J Cardiovasc Ultrasound. 2012;20:30–6.

    Article  PubMed  Google Scholar 

  24. Youssef W, Russell AS. Cardiac, ocular, and renal manifestations of seronegative spondyloarthropathies. Curr Opin Rheumatol. 1990;2:582–5.

    Article  PubMed  CAS  Google Scholar 

  25. Peeters AJ, ten Wolde S, Sedney MI, et al. Heart conduction disturbance: an HLA-B27 associated disease. Ann Rheum Dis. 1991;50:348–50.

    Article  PubMed  CAS  Google Scholar 

  26. Dik VK, Peters MJ, Dijkmans PA, et al. The relationship between disease-related characteristics and conduction disturbances in ankylosing spondylitis. Scand J Rheumatol. 2010;39:38–41.

    Article  PubMed  CAS  Google Scholar 

  27. Kazmierczak J, Peregud-Pogorzelska M, Biernawska J, et al. Cardiac arrhythmias and conduction disturbances in patients with ankylosing spondylitis. Angiology. 2007;58:751–6.

    Article  PubMed  Google Scholar 

  28. Caliskan M, Erdogan D, Gullu H, et al. Impaired coronary microvascular and left ventricular diastolic functions in patients with ankylosing spondylitis. Atherosclerosis. 2008;196:306–12.

    Article  PubMed  CAS  Google Scholar 

  29. Kırış A, Karkucak M, Karaman K, et al. Patients with ankylosing spondylitis have evidence of left ventricular asynchrony. Echocardiography. 2012 Mar 9 [Epub ahead of print]

  30. Yalcin H, Guler H, Gunay E, et al. Left ventricular wall function abnormalities in patients with ankylosing spondylitis evaluated by gated myocardial perfusion scintigraphy. Rev Esp Med Nucl. 2011;30:292–6.

    Article  PubMed  CAS  Google Scholar 

  31. Acar G, Sayarlioglu M, Akcay A, et al. Assessment of atrial electromechanical coupling characteristics in patients with ankylosing spondylitis. Echocardiography. 2009;26:549–57.

    Article  PubMed  Google Scholar 

  32. Gunes Y, Tuncer M, Guntekin U, et al. Effects of ankylosing spondylitis on the heart. Acta Cardiol. 2009;64:385–92.

    Article  PubMed  Google Scholar 

  33. Kang JH, Chen YH, Lin HC. Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population-based study. Ann Rheum Dis. 2010;69:1165–8.

    Article  PubMed  Google Scholar 

  34. Divecha H, Sattar N, Rumley A, et al. Cardiovascular risk parameters in men with ankylosing spondylitis in comparison with non-inflammatory control subjects: relevance of systemic inflammation. Clin Sci. 2005;109:171–6.

    Article  PubMed  CAS  Google Scholar 

  35. Papadakis JA, Sidiropoulos PI, Karvounaris SA, et al. High prevalence of metabolic syndrome and cardiovascular risk factors in men with ankylosing spondylitis on anti-TNFalpha treatment: correlation with disease activity. Clin Exp Rheumatol. 2009;27:292–8.

    PubMed  CAS  Google Scholar 

  36. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685–95.

    Article  PubMed  CAS  Google Scholar 

  37. Angel K, Provan SA, Gulseth HL, et al. Tumor necrosis factor-alpha antagonists improve aortic stiffness in patients with inflammatory arthropathies: a controlled study. Hypertension. 2010;55:333–8.

    Article  PubMed  CAS  Google Scholar 

  38. Angel K, Provan SA, Fagerhol MK, et al. Effect of 1-year anti-TNF-α therapy on aortic stiffness, carotid atherosclerosis, and calprotectin in inflammatory arthropathies: a controlled study. Am J Hypertens. 2012 Mar 1 [Epub ahead of print].

  39. van Eijk IC, Peters MJ, Serné EH, et al. Microvascular function is impaired in ankylosing spondylitis and improves after tumour necrosis factor alpha blockade. Ann Rheum Dis. 2009;68:362–6.

    Article  PubMed  Google Scholar 

  40. Syngle A, Vohra K, Sharma A, Kaur L. Endothelial dysfunction in ankylosing spondylitis improves after tumor necrosis factor-alpha blockade. Clin Rheumatol. 2010;29:763–70.

    Article  PubMed  Google Scholar 

  41. Senel S, Cobankara V, Taskoylu O, et al. Effect of infliximab treatment on QT intervals in patients with ankylosing spondylitis. J Investig Med. 2011;59:1273–5.

    PubMed  CAS  Google Scholar 

  42. Kiortsis DN, Mavridis AK, Filippatos TD, et al. Effects of infliximab treatment on lipoprotein profile in patients with rheumatoid arthritis and ankylosing spondylitis. J Rheumatol. 2006;33:921–3.

    PubMed  CAS  Google Scholar 

  43. Mathieu S, Dubost JJ, Tournadre A, et al. Effects of 14 weeks of TNF alpha blockade treatment on lipid profile in ankylosing spondylitis. Joint Bone Spine. 2010;77:50–2.

    Article  PubMed  CAS  Google Scholar 

  44. Spanakis E, Sidiropoulos P, Papadakis J, et al. Modest but sustained increase of serum high density lipoprotein cholesterol levels in patients with inflammatory arthritides treated with infliximab. J Rheumatol. 2006;33:2440–6.

    PubMed  CAS  Google Scholar 

  45. van Eijk I, de Vries MK, Levels JH, et al. Improvement of lipid profile is accompanied by atheroprotective alterations in high-density lipoprotein composition upon tumor necrosis factor blockade: a prospective cohort study in ankylosing spondylitis. Arthritis Rheum. 2009;60:1324–30.

    Article  PubMed  Google Scholar 

  46. Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med. 1998;338:1516–20.

    Article  PubMed  CAS  Google Scholar 

  47. •• Peters MJ, Symmons DP, McCarey D, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69:325–31. Evidence-based recommendations, from the EULAR, for cardiovascular risk management in patients with inflammatory arthritis.

    Article  PubMed  CAS  Google Scholar 

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Disclosure

Dr. Nurmohamed has served as a consultant for Roche, Schering-Plough, Bristol-Myers Squibb, UCB, Wyeth, Pfizer, and Merck Sharp & Dohme Corp. and has received congress travel/accommodations support from Roche, Merck Sharp & Dohme Corp., and UCB.

Dr. van der Horst-Bruinsma has received grant support from Merck Sharp & Dohme Corp., Abbott Laboratories, and Pfizer; has received payment for giving lectures from Abbott Laboratories and Pfizer; and has received congress travel/accommodations support from Roche, Merck Sharp & Dohme Corp., and UCB.

Dr. Maksymowych has served as a consultant for Abbott Laboratories, Janssen Pharmaceutica, Merck & Co., Amgen, Pfizer, and Eli Lilly and Company and has received grant support from Abbott Laboratories, Amgen, Merck & Co., Janssen Pharmaceutica, and Pfizer.

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Authors and Affiliations

  1. Department of Internal Medicine, VU University Medical Centre, PO Box 7057, Amsterdam, The Netherlands

    Michael T. Nurmohamed

  2. Department of Rheumatology, VU University Medical Centre, PO Box 7057, Amsterdam, The Netherlands

    Michael T. Nurmohamed & Irene van der Horst-Bruinsma

  3. Jan van Breemen Research Institute|Reade, Amsterdam, The Netherlands

    Michael T. Nurmohamed

  4. Department of Medicine, University of Alberta, Edmonton, Canada

    Walter P. Maksymowych

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  1. Michael T. Nurmohamed
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  2. Irene van der Horst-Bruinsma
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  3. Walter P. Maksymowych
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Correspondence to Michael T. Nurmohamed.

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Nurmohamed, M.T., van der Horst-Bruinsma, I. & Maksymowych, W.P. Cardiovascular and Cerebrovascular Diseases in Ankylosing Spondylitis: Current Insights. Curr Rheumatol Rep 14, 415–421 (2012). https://doi.org/10.1007/s11926-012-0270-6

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  • DOI: https://doi.org/10.1007/s11926-012-0270-6

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