Cardiovascular risk parameters in men with ankylosing spondylitis in comparison with non-inflammatory control subjects: relevance of systemic inflammation

Abstract

Men with AS (ankylosing spondylitis) are at elevated risk for CHD (coronary heart disease) but information on risk factors is sparse. We compared a range of conventional and novel risk factors in men with AS in comparison with healthy controls and, in particular, determined the influence of systemic inflammation. Twenty-seven men with confirmed AS and 19 controls matched for age were recruited. None of the men was taking lipid-lowering therapy. Risk factors inclusive of plasma lipids, IL-6 (interleukin-6), CRP (C-reactive protein), vWF (von Willebrand factor), fibrin D-dimer, ICAM-1 (intercellular cell-adhesion molecule-1) and fibrinogen were measured, and blood pressure and BMI (body mass index) were determined by standard techniques. A high proportion (70%) of men with AS were smokers compared with 37% of controls (P = 0.024). The AS patients also had a higher BMI. In analyses adjusted for BMI and smoking, men with AS had significantly higher IL-6 and CRP (approx. 9- and 6-fold elevated respectively; P < 0.001), fibrinogen (P = 0.013) and vWF (P = 0.008). Total cholesterol and HDL-C (high-density lipoprotein cholesterol) were lower (P < 0.05 and P = 0.073 respectively) in AS and thus the ratio was not different. Pulse pressure was also significantly higher in AS (P = 0.007). Notably, adjustment for IL-6 and CRP levels rendered all case-control risk factor differences, except pulse pressure, non-significant. In accordance with this finding, IL-6 correlated positively (r = 0.74, P < 0.001) with fibrinogen, but negatively (r = -0.46, P = 0.016) with total cholesterol concentration. In conclusion, men with AS have perturbances in several CHD risk factors, which appear to be driven principally by systemic inflammatory mediators. Inflammation-driven atherogenesis potentially contributes to the excess CHD risk in AS.

Effects of tumor necrosis factor blockade on cardiovascular risk factors in psoriatic arthritis: A double‐blind, placebo‐controlled study

“…We acknowledge that the effects of TNF modulation in patients with PsA and psoriasis may potentially differ from its effects in patients with other autoimmune diseases. However, the range of risk factor abnormalities at baseline and the association of CRP with many parameters were generally similar to findings in RA and related conditions (e.g., ankylosing spondylitis) (15). We also acknowledge that determination of fasting triglyceride and insulin levels would have been advantageous, but it is noteworthy that all other lipids and other measured risk factors are not appreciably altered by nonfasting status.…”

“…The evidence for causal links between these pathways is stronger in the context of high-grade inflammation, which occurs in a variety of autoimmune inflammatory conditions such as RA or ankylosing spondylitis (1,15). Of specific interest to the present study, psoriasis has recently been reported to confer an independent risk of myocardial infarction, with the relative risk being greatest in young patients with severe psoriasis (16).…”

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

“…Although specific CV disorders (valvular disease and conduction disturbances) occur more frequently in AS (4,5), accelerated atherosclerotic disease probably contributes to the increased CV risk as well (6,7). Atherosclerosis is a multifactorial process, but its most well-established risk factor is dyslipidemia.…”

“…Inflammation deteriorates the lipid profile, as characterized by low HDL, total cholesterol, and Apo A-I levels and increased levels of low-density lipoprotein cholesterol (LDL-c), triglycerides, and Apo B. Indeed, several investigators have reported that patients with inflammatory rheumatic diseases have a deteriorated lipid profile (4,6,(8)(9)(10).…”

Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations

“…Although the association between smoking and CV risk in RA is less significant than in the general population [Symmons and Gabriel, 2011], a higher prevalence of smoking is well-established in RA, SA, and PsA compared with controls [Boyer et al 2011;Divecha et al 2005;Favato, 2008;Peters et al 2004]. Hypertension is common in RA but it is not clear whether its incidence differs from that of the general population [Boyer et al 2011;Liao and Solomon, 2013;Protogerou et al 2013].…”