Uveitis as a Risk Factor for Developing Acute Myocardial Infarction in Ankylosing Spondylitis: A National Population-Based Longitudinal Cohort Study

Abstract

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disease. Excess cardiovascular risks were well recognized in patients with AS and were attributed to prolonged systemic inflammation. Uveitis is one of the most common extra-articular symptoms of AS and is also considered an indicator of systemic inflammation. This study aimed to investigate whether uveitis was a risk factor for developing acute myocardial infarction (AMI) in patients with AS using the National Health Insurance Research Database (NHIRD).MethodsData were collected from the NHIRD over a fifteen-year period. Variables were analyzed using the Pearson chi-square test and Fisher’s exact test. Risk factors for the occurrence of AMI were examined by calculating hazard ratio. Kaplan-Meier analysis was performed to compare the cumulative incidence of AMI in the uveitis and non-uveitis cohorts.ResultsA total of 5905 patients with AS were enrolled, including 1181 patients with uveitis (20%) and 4724 patients without uveitis (80%). The Kaplan–Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI than the non-uveitis group (p < 0.001). The adjusted hazard ratio (aHR) of AMI was higher in the uveitis group than in the non-uveitis group (aHR = 1.653, p < 0.001). Stratified analysis revealed that patients with uveitis had an increased risk of developing AMI regardless of their sex (male/female aHR = 1.688/1.608, p < 0.001). Patients with uveitis in all age groups were independently associated with an increased risk of developing AMI compared to those without uveitis (20–39 years/40–59 years/≥ 60 years, aHR = 1.550, 1.579, 3.240, p < 0.001). Patients with uveitis had a higher probability of developing AMI regardless of comorbidities. Uveitis patients with comorbidities had a higher risk of developing AMI compared to uveitis patients without comorbidities.ConclusionUveitis is a significant risk factor for developing AMI in patients with AS. Physicians should be aware of the potential cardiovascular risk in AS patients with uveitis, especially simultaneously with other traditional risk factors of AMI. Further prospective studies are needed to elucidate the underlying mechanism between uveitis and AMI in patients with AS.

Association Between Atherosclerosis-Related Cardiovascular Disease and Uveitis: A Systematic Review and Meta-Analysis

“…To identify the potential origin of heterogeneity, leave-one-out sensitivity analysis was conducted. Of these three cohort studies, Bai et al [ 27 ], included AS patients with a history of AAU, whereas the other two studies (Feng et al [ 28 ], and Lai et al [ 29 ]) included AS patients with current combined uveitis. However, excluding Bai et al [ 27 ]., did not change the significant difference, but reduced the individual heterogeneity (HR = 1.66, 95% CI = 1.52–1.82, p < 0.00001; I 2 = 0%, p = 0.89) ( Figure S1 ), suggesting that significant heterogeneity was caused by the differences in recency of uveitis.…”

“… ( A ) Forest plots showing pooled HR with 95% CI of atherosclerosis-related CVD for patients with uveitis versus those without. ( B ) Forest plots showing subgroup uveitis and atherosclerosis-related CVD [ 27 , 28 , 29 ]. …”

Validation of diagnosis algorithms for ankylosing spondylitis in claim‐based database

“…23 However, in realworld studies derived from healthcare databases, administrative codes might not be enough to represent the actual disease statuses due to various reasons, such as billing policy and inappropriate use of codes. 9,24 Therefore, misclassification biases could exist due to the imprecise selection of ICD codes in database-based studies. To address the potential misclassification bias, validation studies were conducted to validate the algorithms utilized in real-world studies.…”

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

“…The role of the extra-articular manifestations in the atherosclerotic burden of axSpA is another intriguing question to clarify. Psoriasis [2] and IBD [3] have been independently related to increased CV risk by themselves, and uveitis was found to be a significant risk factor for developing acute myocardial infarction in patients with AS in a recent retrospective cohort study with 5905 patients from the Taiwanese National Database [43].…”