Cardiovascular risk estimation in young patients with ankylosing spondylitis: A new model based on a prospective study in Constanta County, Romania

Abstract

Cardiovascular (CV) risk assessment charts are useful in establishing a patient therapeutic plan, but the most commonly used charts have essential limitations when applied to special populations. Our aim was to determine whether the Systematic Coronary Risk Evaluation (SCORE) chart underestimates the CV risk in young patients with ankylosing spondylitis (AS) and to promote the necessity of new risk assessment models. We conducted a prospective study in Constanta County, Romania including 70 consecutive patients ≤50 years of age, previously diagnosed with AS, without a history of established CV disease, diabetes mellitus and chronic kidney disease. We estimated the CV risk using SCORE based on total cholesterol, applied for a high-risk population, such as the Romanian population. Estimation of CV risk was also conducted with the relative risk (RR) chart, considering the following variables: Smoking, systolic blood pressure and total cholesterol. The majority of patients (n=46, 65.71%) had low risk according to the SCORE chart and only 24 (34.28%) were found to have moderate CV risk; none of them with high or very high CV risk. Ten patients (21.74%) of the 46 who were considered to have a low risk based on the SCORE system presented with carotid plaques. Twelve patients (50%) of the remaining 24 with moderate CV risk were found to have carotid plaques. According to 2016 'European Society of Cardiology' (ESC) guidelines, 22 of all 70 patients were at high/very high CV risk due to the presence of carotid plaques. Comparing the RR chart with carotid plaque detection, only 4 out of 30 (13.3%) patients with RR=1 had carotid plaques; the frequency was higher in those with RR>1. Our results attested that the SCORE system underestimates the risk in patients with carotid plaques. Carotid ultrasound provided a more heightened sensitivity of the RR chart. C-reactive protein (CRP) >3 mg/dl is associated with RR>1, making this chart a better CV risk predictive system in this particular category of patients.

The Evaluation of Cardiovascular Disease Risk Factors Knowledge Levels of Patients with Ankylosing Spondylitis

“…Çalışmalarda AS hastalarında HT tanı oranı %4,11-22,8 arasında değişmektedir. 11,14,44,46 Çalışmamızda benzer şekilde bu oran %7,9 bulunmuştur. KVH açısından bir diğer risk faktörü de DM'dir.…”

“…AS hastalarında obezite oranı %13,5-31,4 arasında değişmektedir. 2,14,44,46 Çalışmamızda bu oran %5,9 bulunmuştur. Çalışmamızdaki genç erkek hâkimiyeti obezite oranının az olmasının nedeni olabilir.…”

“…Bu hastalarda mortalitenin %20-40'ından kardiyovasküler olaylar sorumlu tutulmaktadır. 3,[13][14][15] Bir çalışmada; AS tanılı bireylerin, AS olmayan bireylere göre KVH açısından en az %25 artmış riske sahip olduğu tespit edilmiştir. 11 Yine AS hastalarının, aynı yaş ve cinsiyette AS olmayan kişilere göre kardiyovasküler veya serebrovasküler bir hastalık nedeniyle hastaneye yatma riskinde en az %30 oranında artışa sahip olduğu tespit edilmiştir.…”

No evidence of a causal relationship between ankylosing spondylitis and cardiovascular disease: a two-sample Mendelian randomization study

“…Furthermore, there is ongoing controversy surrounding the association between AS and atherosclerosis ( 11 , 12 ). It is worth noting that comorbidities commonly observed in AS, such as hypertension (HTN) and diabetes mellitus (DM) ( 13 ), along with well-established risk factors like smoking, obesity, and reduced physical activity, are strongly associated with CVD morbidity and mortality ( 14 , 15 ). Consequently, it remains uncertain whether the development of CVD is directly attributed to AS itself or indirectly influenced by the comorbidities associated with AS.…”

Exploration of the Immuno-Inflammatory Potential Targets of Xinfeng Capsule in Patients with Ankylosing Spondylitis Based on Data Mining, Network Pharmacology, and Molecular Docking

“…Ankylosing spondylitis (AS) is a kind of chronic inflammatory arthritis that mainly afflicts the axial and sacroiliac joints [ 1 ]. It occurs more frequently in men with a high incidence and disability rate [ 2 , 3 ]. If AS is not treated appropriately, this inflammatory damage normally causes chronic back pain and morning stiffness in patients, thereby resulting in the restriction of spinal mobility and functional impairment status of patients [ 4 – 6 ], which seriously affect the life quality of patients.…”