A Statewide Study of Cardiovascular Outcomes in Patients with Ankylosing Spondylitis

Numerous studies have shown that ankylosing spondylitis is associated with an increased risk of cardiovascular disease including heart failure, acute myocardial infarction, stroke, transient ischemic attack, and cardiovascular mortality. This may be a direct result of inflammation or an indirect one from the use of anti-inflammatory drugs needed to treat ankylosing spondylitis, or from the coexistence of traditional risk factors. This is a retrospective case-control study of the occurrence of cardiovascular events in ankylosing spondylitis patients and matched controls. Data was obtained from the Myocardial Infarction Data Acquisition System, a statewide database containing hospitalizations for cardiovascular diseases in New Jersey. Two types of analyses were performed: unadjusted and adjusted for comorbidities. The odds ratio of developing heart failure in the ankylosing spondylitis group vs. matched controls was 1.59 (95% CI 1.44 - 1.76, p < 0.001) in the unadjusted model and 1.31 (95% CI 1.18 - 1.47, p < 0.001) after adjustment for hypertension, diabetes mellitus, acute kidney failure/chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, and hyperlipidemia. Similarly, risks of myocardial infarction and cardiovascular mortality in ankylosing spondylitis patients were significantly higher in both, unadjusted and adjusted models while odds ratio for transient ischemic attack became non-significant after the adjustment. Ankylosing spondylitis is associated with increased rates of the cardiovascular disease that are probably due of pathophysiologic changes attendant to the disease, as well as the presence of the comorbidities.