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. 2017 May 18;19(1):102.
doi: 10.1186/s13075-017-1315-z.

Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study

Karin Bengtsson  1 , Helena Forsblad-d'Elia  2   3 , Elisabeth Lie  2 , Eva Klingberg  2 , Mats Dehlin  2 , Sofia Exarchou  4 , Ulf Lindström  2 , Johan Askling  5 , Lennart T H Jacobsson  2
Affiliations

Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study

Karin Bengtsson et al. Arthritis Res Ther. .

Abstract

Background: To investigate the risk of first-time acute coronary syndrome (ACS), stroke and venous thromboembolism (VTE) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated spondyloarthritis (uSpA), compared to each other and to the general population (GP).

Methods: This is a prospective nationwide cohort study. Cohorts with AS (n = 6448), PsA (n = 16,063) and uSpA (n = 5190) patients and a GP (n = 266,435) cohort, were identified 2001-2009 in the Swedish National Patient and Population registers. The follow-up began 1 January 2006, or 6 months after the first registered spondyloarthritis (SpA) diagnosis thereafter, and ended at ACS/stroke/VTE event, death, emigration or 31 December 2012. Crude and age- and sex-standardized incidence rates (SIRs) and hazard ratios (HRs) were calculated for incident ACS, stroke or VTE, respectively.

Results: Standardized to the GP cohort, SIRs for ACS were 4.3, 5.4 and 4.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort, respectively, compared to 3.2 in the GP cohort. SIRs for stroke were 5.4, 5.9 and 5.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort compared to 4.7 in the GP cohort. Corresponding SIRs for VTE were 3.6, 3.2 and 3.5 events per 1000 person-years at risk compared to 2.2 in the GP cohort. Age-and sex-adjusted HRs (95% CI) for ACS events were significantly increased in AS (1.54 (1.31-1.82)), PsA (1.76 (1.59-1.95)) and uSpA (1.36 (1.05-1.76)) compared to GP. Age-adjusted HRs for ACS was significantly decreased in female AS patients (0.59 (0.37-0.97)) compared to female PsA patients. Age-and sex-adjusted HRs for stroke events were significantly increased in AS (1.25 (1.06-1.48)) and PsA (1.34 (1.22-1.48)), and nonsignificantly increased in uSpA (1.16 (0.91-1.47)) compared to GP. For VTE the age-and sex-adjusted HRs for AS, PsA and uSpA were equally and significantly increased with about 50% compared to GP.

Conclusions: Patients with AS, PsA and uSpA are at increased risk for ACS and stroke events, which emphasizes the importance of identification of and intervention against cardiovascular risk factors in SpA patients. Increased alertness for VTE is warranted in patients with SpA.

Keywords: Acute coronary syndrome; Ankylosing spondylitis; Cardiovascular disease; Cohort; Psoriatic arthritis; Spondylarthropathies; Spondyloarthritis; Stroke; Undifferentiated spondyloarthritis; Venous thromboembolism.

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Figures

Fig. 1
Fig. 1
Age- and sex-adjusted hazard ratios (HRs) for acute coronary syndrome (ACS). Age- and sex-adjusted HRs, overall and stratified by sex, are presented with 95% confidence interval (CI) in patients with AS, PsA, and uSpA, using GP comparators and PsA patients as reference. AS ankylosing spondylitis, PsA psoriatic arthritis, uSpA undifferentiated spondyloarthritis
Fig. 2
Fig. 2
Age- and sex-adjusted hazard ratios (HRs) for composite stroke. Age- and sex-adjusted HRs, overall and stratified by sex, are presented with 95% confidence interval (CI) in patients with AS, PsA, and uSpA, using GP comparators and PsA patients as reference. AS ankylosing spondylitis, PsA psoriatic arthritis, uSpA undifferentiated spondyloarthritis
Fig. 3
Fig. 3
Age- and sex-adjusted HRs for ischemic stroke, hemorrhagic stroke and transient ischemic attack (TIA). Age- and sex-adjusted hazard ratios (HRs) are presented with 95% confidence interval (CI) in patients with AS, PsA, and uSpA, using GP comparators as reference. AS ankylosing spondylitis, PsA psoriatic arthritis, uSpA undifferentiated spondyloarthritis
Fig. 4
Fig. 4
Age- and sex-adjusted hazard ratios (HRs) for venous thromboembolism (VTE). Age- and sex-adjusted HRs, overall and stratified by sex, are presented with 95% confidence interval (CI) in patients with AS, PsA, and uSpA, using GP comparators and PsA patients as reference. AS ankylosing spondylitis, PsA psoriatic arthritis, uSpA undifferentiated spondyloarthritis
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