Original articleInvestigation of effects of different treatment modalities on structural and functional vessel wall properties in patients with ankylosing spondylitis
Introduction
Ankylosing spondylitis (AS) is a chronic inflammatory disease involving mainly the sacroiliac joints and the spine. However, AS may show some extraarticular manifestations including cardiovascular involvement [1], [2]. Cardiovascular involvement in AS includes aortic involvement causing aortic regurgitation, myocardial involvement associated with conduction defects, arrhythmias and pericardial involvements, in the course of AS, is a very important extraarticular complication. The overall mortality of the patients with AS is 1.5 times higher than the normal population, and circulatory or cardiovascular involvement has been estimated to account for 20–40% of this excess mortality [1], [3], [4], [5]. The exact mechanism underlying the association between AS and the cardiovascular involvement has not been fully understood. However, inflammation plays an important role in the pathogenesis of atherosclerosis and it is likely that chronic systemic inflammation contributes to the increased cardiovascular mortality and morbidity. In a recent study, the presence of subclinical atherosclerosis was identified in AS 2. However, dyslipidemia, smoking, diabetes mellitus and hypertension also play important roles for development of atherosclerosis [6]. Another study indicated that patients with AS have higher BMI and are higher rate of cigar smokers compared to the controls. And those patients had more pronounced parameters showing systemic inflammation. It is also known that high BMI and smoking are among to atherosclerosis risk factors. However, the association between atherosclerosis and AS is still debated [7], [8].
Pulse wave velocity (PWV) is a marker for arterial stiffness and increased vascular stiffness recently being recognized as an independent risk factor for cardiovascular disease (CVD) [9]. Measurement of the intima-media thickness of the common or internal carotid artery (IMT-C) with a high-resolution ultrasonography is an important indicator for and indirect way of assessing the early stages of atherosclerosis [10].
Recent studies indicates an increased subclinical atherosclerosis in AS patients without clinically evident CVD and TNF-alpha blockade does not seem to improve arterial stiffness in AS patients, but those studies suffer from lack of statistical power and not clearly established the effects of TNF-alpha blockade therapy [2], [10], [11].
The aim of this study was to evaluate the level of subclinical atherosclerosis, and to evaluate effects of different treatment modalities on vascular structural and functional changes, assessed by PWV and IMT-C, in AS patients in comparison with controls.
Section snippets
Methods
This study was conducted between June and November 2008. Sixty-seven AS patients and 34 healthy controls were enrolled. Informed consent was obtained before the examination, and approval for the study was granted by the local Ethical Committee. All the patients met The New York diagnostic criteria for AS [12]. The patients with AS had long-standing disease duration (mean ± standard deviation, 7.7 ± 4.8 years).
We excluded patients with diabetes mellitus (fasting blood glucose > 7 mmol/l) and patients
Results
Clinical characteristics of patients with AS are given in Table 1. The mean disease duration was 7.7 ± 4.8 years (y). The AS patients also had a significantly higher mean CRP level than healthy controls, indicating systemic inflammation. The controls were consisted of 25 men and nine women. The mean age of controls was 37.7 ± 8.2 y. There were no significant differences between the patients and control groups with regard to mean age, gender distribution, number of smokers, blood pressure levels,
Discussion
In this study, by evaluating the presence and level of subclinical atherosclerosis in AS patients through IMT-C and PWV, markers of subclinical atherosclerosis, and vascular stiffness in patients on anti-TNF alpha, it was found that AS patients had higher PWV but there were no statistically significant difference between patients with AS and controls with respect to the IMT-C levels.
It has been shown that male AS patients have a 40% higher cardiovascular mortality risk than to the general
Conflict of interest statement
None of the authors has any conflicts of interest to declare.
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