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Cardiovascular risk management in patients with active ankylosing spondylitis: a detailed evaluation
Sjoerd C Heslinga1,2,3, Inge A Van den Oever4,5, Alper M Van Sijl6,7,8
1Department of Rheumatology, Reade, Amsterdam, Netherlands. s.heslinga@reade.nl.
Insights
Ankylosing spondylitis patients have higher rates of hypertension and smoking, increasing cardiovascular risk. While most eligible patients received cardiovascular risk medication, treatment targets were frequently unmet, highlighting challenges in cardiovascular risk management for this population.
Area of Science:
- Rheumatology
- Cardiology
- Public Health
Background:
- Ankylosing spondylitis (AS) is linked to elevated cardiovascular (CV) risk due to systemic inflammation and prevalent CV risk factors.
- Cardiovascular risk management (CV-RM) is crucial for reducing CV mortality and morbidity in AS patients.
- This study assesses CV risk and guideline adherence in AS patients within the Dutch healthcare system.
Purpose of the Study:
- To evaluate the prevalence of cardiovascular risk factors in ankylosing spondylitis patients.
- To assess adherence to the Dutch cardiovascular risk management guideline in AS patients.
- To identify challenges in achieving treatment targets for cardiovascular risk factors in AS.
Main Methods:
- A cohort of 254 consecutive AS patients eligible for TNF-α inhibitor treatment was studied.
- Prevalence of CV risk factors in AS patients was compared to the general Dutch population using national data.
- CV risk was calculated for AS patients over 40 years old, and treatment initiation and target achievement were assessed.
Main Results:
- AS patients showed substantially higher prevalences of hypertension (41% vs 31%) and smoking (43% vs 27%) compared to the general population.
- Of 138 AS patients over 40, 37% (51 patients) indicated CV risk treatment.
- CV risk medication was initiated in 82% of eligible patients, but only 24% reached treatment targets for hypertension or hypercholesterolemia.
Conclusions:
- Elevated hypertension and smoking rates underscore the necessity of CV-RM in AS.
- Despite high medication initiation rates, achieving treatment targets for CV risk factors remains a significant challenge for physicians managing AS patients.
- Effective CV-RM in AS requires addressing the gap between medication initiation and target attainment.
Background:
Ankylosing spondylitis (AS) is an inflammatory disease with documented elevated cardiovascular (CV) risk due to systemic inflammation and a higher prevalence of CV risk factors. CV risk management (CV-RM) could be an effective method to reduce CV mortality and morbidity in AS patients. We assessed CV risk and evaluated guideline adherence according to the Dutch CV-RM guideline.
Methods:
This study was conducted with a cohort of consecutive AS patients eligible for treatment with a tumor necrosis factor (TNF) -α inhibitor. Data from the Dutch National Institute for Public Health and Environment was used to compare the prevalence of CV risk factors in AS patients with the Dutch background population.
Results:
In total, 254 consecutive AS patients were included. The prevalences of hypertension (41% vs 31%) and smoking (43% vs 27%) were substantially higher in AS patients as compared to the general Dutch background population. Of 138 AS patients older than 40 years the 10-years CV risk could be calculated. Fifty-one of these 138 patients (37%) had an indication for CV risk treatment. CV risk treatment was initiated in 42 of the 51 (82%), however, in only 12 of the 51 (24%) patients treatment targets for either hypertension or hypercholesterolemia were reached.
Conclusion:
The increased rates of hypertension and smoking illustrate the importance of CV-RM in AS patients. Although the majority of all AS patients eligible for CV-RM received CV risk medication, CV-RM remains a challenge for treating physicians, as treatment targets were not achieved in three-quarter of the eligible patients.
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