The Risk of Cardiovascular Diseases in Axial Spondyloarthritis. Current Insights

Abstract

There is an increased cardiovascular (CV) risk in axial spondyloarthritis (axSpA), leading to increased CV mortality and morbidity in these patients. The factors that may explain this enhanced CV risk in axSpA are multiple, including traditional CV risk factors such as smoking, but also the inflammatory process and probably the use of non-steroidal anti-inflammatory drugs (NSAIDs). The CV involvement of axSpA may be detected at an early and pre-clinical stage, using non-invasive techniques. While NSAIDs play a deleterious role in the CV risk of axSpA, TNF inhibitors seem to have a beneficial impact, but this remains to be demonstrated in specific clinical studies. More data are needed to determine the potential effects of IL-17 inhibitors on the CV risk of axSpA. CV comorbidity has been mainly assessed in the radiographic form of axSpA, while limited data are available in patients with the non-radiographic form. The current management of axSpA must consider this CV comorbidity according to the EULAR recommendations. Rheumatologists play a determinant role in the detection of CV risk and current management of these patients is focused on the control of disease activity, suppression of inflammation, screening for and management of traditional CV risk factors, as well as the restriction of NSAID use.

Factors associated with atherosclerosis in radiographic and non-radiographic axial spondyloarthritis. A multicenter study on 838 patients

“…Increasing evidence indicates a beneficial effect of both synthetic and biological DMARDs in the CV risk of axSpA [42]. Nevertheless, these therapies were found to be associated with subclinical atherosclerosis and CV events in our series.…”

“…registry showed more severe radiological damage than patients from our series, with mSASSS scores three times higher. Besides, they were biological-naïve, which constitutes a relevant difference considering TNF-inhibitors' influence over structural damage [41] and atherosclerosis [42].…”

Inflammation, new bone formation and aorta

“…The heterogeneous population and possible selection bias might hamper the strength of evidence and generalizibility of our conclusions. For instance, it is known that long‐term disease with AS is accompanied by CAD due to accelerated atherosclerosis; 31 however, this might not be a big issue because our patients were newly diagnosed (~9 months). As another example, the majority of our CAD patients had a recent PCI (~4.5 months), which explains higher CRP levels detected that probably reflected underlying inflammatory unstable plaque pathophysiologies.…”

The Use of Janus Kinase Inhibitors in Axial Spondyloarthritis: Current Insights

“…The Food and Drug Administration (FDA), but not the European Medicines Agency (EMA), extends this recommendation to two other JAKis, namely upadacitinib and baricitinib. The CV risk is increased in axSpA [ 53 ], and, thus, caution is certainly required in patients with axSpA and CV comorbidity.…”