Cardiovascular Disease in Patients with Ankylosing Spondylitis from the Rheumatology Outpatient Clinic of the UFMS-affiliated Hospital

Abstract Background: Cardiovascular diseases are a major cause of morbidity and mortality today. Despite its wide distribution, it presents particularly prevalent in certain groups of individuals, particularly when exposed to a higher degree of inflammation, giving increased cardiovascular risk. Rheumatic diseases expose their holders to this increased cardiovascular risk condition; however only recently have been associated with spondyloarthritis, particularly ankylosing spondylitis (AS). For being a classically autoimmune disease related to HLA histocompatibility system, AS may present phenotypic variations in different ethnic groups with possible diverse cardiovascular consequences. Objectives: To estimate the prevalence of cardiovascular disease (CVD) and the cardiovascular risk profile, correlating the time since diagnosis and activity of ankylosing spondylitis (AS) in patients from the rheumatology outpatient clinic of the UFMS-affiliated hospital. Methods: Of 55 patients with AS, 42 were selected consecutively and compared to a control group (CG) in a cross-sectional study. Patients with diabetes, indigenous background and pregnant women were excluded. Quantitative variables were assessed by use of Student t test, while qualitative variables, by chi-square test. The patients underwent electrocardiography, echocardiography and carotid Doppler examination, measurement of serum lipid levels and inflammatory markers, and were stratified according to global cardiovascular risk. The AS activity and impairment were evaluated by use of the BASMI, BASDAI, BASFI and ASDAS. Results: Mean age, 42.87 ± 12.37 years; time since AS diagnosis, 10.76 ± 8.74 years. There was no difference in cardiovascular risk stratification between the groups, most of the patients being at high or moderate risk (AS: 64.3%, and CG: 52%, p = 0.134). The prevalence of manifest CVD (2%) showed no difference between the groups, except for right bundle-branch block (AS: 14%, and CG: 2%, p = 0.027). The prevalence of subclinical CVD showed no difference between the groups, except for higher carotid medial-intimal thickness (CIMT) in the AS group (AS: 1.82 ± 2.63, and CG: 0.67 ± 0.16, p = 0.018). There was no correlation between AS activity or inflammatory markers and CVD, but with time since AS diagnosis and CIMT (p = 0.039, r = 0.328). Conclusions: Prevalence of CVD and risk factors was similar in the groups. Subclinical atherosclerosis degree was higher in the AS group, related to the time since diagnosis, but was independent of the cardiovascular risk factors or inflammation. Most patients with AS are at high cardiovascular risk.

摘要 背景：心血管疾病是当前全球发病率与死亡率的主要诱因。尽管其分布广泛，但在特定人群中尤为高发，尤其是当个体暴露于更高程度的炎症状态时，心血管风险会显著升高。风湿性疾病会使患者面临此类升高的心血管风险；然而直到近年，这类疾病才与脊柱关节炎，尤其是强直性脊柱炎（ankylosing spondylitis, AS）建立明确关联。作为一类与HLA组织相容性系统相关的经典自身免疫性疾病，强直性脊柱炎在不同种族群体中可表现出表型差异，进而可能引发各异的心血管结局。研究目的：评估南马托格罗索联邦大学（UFMS）附属医院风湿科门诊患者的心血管疾病（cardiovascular disease, CVD）患病率与心血管风险谱，并分析强直性脊柱炎确诊时长与疾病活动度的相关性。方法：本研究为横断面研究，从55名确诊强直性脊柱炎的患者中连续纳入42名，并设置对照组（control group, CG）进行对照。排除合并糖尿病、有原住民血统及妊娠女性的受试者。定量资料采用t检验（Student t test）进行分析，定性资料采用卡方检验（chi-square test）。所有受试者均接受心电图检查、超声心动图检查、颈动脉多普勒检查，检测血清脂质水平与炎症标志物，并依据全球心血管风险分层标准进行风险分级。采用BASMI、BASDAI、BASFI及ASDAS量表评估强直性脊柱炎的疾病活动度与功能受损情况。结果：受试者平均年龄为42.87±12.37岁，强直性脊柱炎确诊平均时长为10.76±8.74年。两组间心血管风险分层无显著差异，多数患者处于高或中度心血管风险（强直性脊柱炎组：64.3%，对照组：52%，p=0.134）。显性心血管疾病患病率为2%，两组间无显著差异，但右束支传导阻滞的患病率存在组间差异（强直性脊柱炎组：14%，对照组：2%，p=0.027）。亚临床心血管疾病患病率组间无显著差异，但强直性脊柱炎组的颈动脉内膜中层厚度（carotid medial-intimal thickness, CIMT）更高（强直性脊柱炎组：1.82±2.63，对照组：0.67±0.16，p=0.018）。强直性脊柱炎的疾病活动度或炎症标志物与心血管疾病无显著相关性，但确诊时长与颈动脉内膜中层厚度存在正相关（p=0.039，r=0.328）。结论：两组受试者的心血管疾病患病率与危险因素水平相似。强直性脊柱炎组的亚临床动脉粥样硬化程度更高，且与确诊时长相关，但独立于心血管危险因素或炎症状态。多数强直性脊柱炎患者处于高心血管风险水平。