Ankylosing spondylitis (AS), an arthritis-related inflammatory disease that affects the spine, has long been linked to an increased risk of heart disease and stroke, but a new study for the first time quantifies the risk. Published online in Arthritis & Rheumatism, the study found that AS increases the risk by as much as 25 to 60 percent, depending on the cardiovascular or cerebrovascular condition. It also found that the increased risk was greatest for younger – age 20 to 39 years – AS patients.     

“This is a real opportunity to make physicians aware [that] this is a population at increased risk,” says Holly Andersen, MD, director of education and outreach at the Perelman Heart Institute at New York-Presbyterian Hospital and Weill Cornell Medical Center. “We’re always looking for populations that may have a higher risk so we can intervene and help prevent this disease.” Dr. Andersen was not involved in the study.

Canadian researchers led by Shelagh M. Szabo, from the Vancouver offices of Oxford Outreach, a health care consultancy group, compared 8,616 patients with an AS diagnosis in a Québec database to a random sample of Québec residents without AS.

They found that, compared with the general population, AS patients had:

  • 58 percent higher risk of valvular heart disease
  • 37 percent higher risk of ischemic heart disease – which includes events like heart attacks and chest pain
  • 36 percent higher risk of other cardiovascular disease at least a 30 percent higher risk of hospitalization for cardiovascular or cerebrovascular disease
  • 34 percent higher risk of congestive heart failure
  • 25 percent higher risk of cerebrovascular disease or stroke

The researchers write that the link between AS and cardiovascular disease likely exists for a variety of reasons, including chronic inflammation from AS, use of nonsteroidal anti-inflammatory drugs, or NSAIDs, and the fact that patients with this condition tend to exercise less than the general population because of their pain. They write that the increased cardiovascular risk was similar in men and women, but was greatest among AS patients between the ages of 20 and 39 years.

Eric Ruderman, MD, a professor of medicine and rheumatology at Northwestern University’s Feinberg School of Medicine in Chicago was not involved in the study, and questions some of the methodologies. However, he says, “The real take-home message is: Look for these things. Pay attention for the possibility of heart disease, and modify those risk factors you can modify.”

Dr. Andersen agrees. The good news is, there are lots of ways to reduce someone’s risk of heart disease, she says. Doctors can screen for heart disease by regularly checking blood pressure and cholesterol levels, and they can work to lower it not just with drugs but also by encouraging healthy lifestyle choices like improving diet, reducing stress, getting enough sleep and being active.

She says this study carries a message for younger AS patients too: You’re never too young to start paying attention.

“I think the whole goal here is, know you have the risk and don’t wait until a problem develops. Address your risk factors now,” Dr. Andersen says.