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Published on: October 27, 2023
Angiotensin-Receptor Blockade Improves Inflammation and Endothelial Dysfunction in Ankylosing Spondylitis: ARB-AS
Nidhi Garg1,2, Pawan Krishan2, Ashit Syngle3
1Chitkara College of Pharmacy, Chitkara University, Punjab, India.
Insights
Olmesartan treatment significantly improved endothelial function and reduced inflammation in ankylosing spondylitis (AS) patients. This suggests olmesartan has immunomodulatory and cardioprotective potential in AS, improving quality of life and decreasing cardiovascular risk.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Cardiovascular disease is the leading cause of premature death in ankylosing spondylitis (AS).
- AS and atherosclerosis share common pathogenic mechanisms, suggesting potential therapeutic targets.
- Angiotensin-receptor blockers (ARBs) have demonstrated benefits in atherosclerotic cardiovascular disease and possess immunomodulatory properties.
Purpose of the Study:
- To investigate the effects of olmesartan on inflammation and endothelial dysfunction in patients with ankylosing spondylitis.
- To evaluate the impact of olmesartan on cardiovascular risk markers and disease activity in AS.
Main Methods:
- A randomized, placebo-controlled trial involving 40 AS patients treated for 24 weeks.
- Patients received either olmesartan (10 mg/day) or placebo as an adjunct to existing antirheumatic drugs.
- Assessed endothelial function (flow-mediated dilation, endothelial progenitor cells, nitrite), inflammation (cytokines, CRP, ESR), oxidative stress (TBARS), disease activity (BASDAI, ASDAS, BASFI), quality of life (HAQDI, SF-36), and cardiovascular risk (SCORE).
Main Results:
- Olmesartan significantly improved flow-mediated dilation (FMD) and endothelial progenitor cell (EPC) populations compared to placebo.
- Significant reductions in inflammatory markers (IL-6, TNF-α, ESR, CRP) and oxidative stress (TBARS) were observed with olmesartan.
- Olmesartan treatment led to significant improvements in disease activity scores (ASDAS, BASDAI, BASFI), quality of life, and reduced cardiovascular risk (SCORE).
Conclusions:
- Olmesartan effectively reduces inflammatory disease activity and improves endothelial function in AS patients.
- The drug demonstrates vasculoprotective and cardioprotective potential, decreasing cardiovascular risk in this population.
- Olmesartan offers immunomodulatory benefits, improving quality of life and suggesting a role in managing AS comorbidities.
Abstract:
Cardiovascular (CV) disease is the leading cause of premature death in ankylosing spondylitis (AS). Atherosclerosis and AS share similar pathogenic mechanisms. The proven benefits of angiotensin-receptor blockers (ARBs) in atherosclerotic cardiovascular disease and their role in immune mediation provide strong rationale to investigate its impact with olmesartan on inflammation and endothelial dysfunction in AS. To investigate the effect of olmesartan on inflammation and endothelial dysfunction in AS. 40 AS patients were randomized to receive 24 weeks of treatment with olmesartan (10 mg/day, n = 20) and placebo ( n = 20) as an adjunct to existing stable antirheumatic drugs. Markers of endothelial function included the following: flow-mediated dilation (FMD) assessed by AngioDefender, endothelial progenitor cells (EPCs) estimated by flow cytometry, nitrite (nitric oxide surrogate), intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) and inflammatory measures including Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis functional index (BASFI); erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); proinflammatory cytokines (interleukin-1 [IL-1], IL-6, tumor necrosis factor-α [TNF-α]) and marker of oxidative stress- thiobarbituric acid reactive substances (TBARS) estimated at baseline and after treatment. Health assessment questionnaire disability index (HAQDI), 36-item short form survey (SF-36), and systematic coronary risk evaluation (SCORE) were estimated using standard tools. FMD improved significantly in the olmesartan group (5.83 ± 0.31% to 7.68 ± 0.27%, p ≤ 0.05) as compared with placebo (5.89 ± 0.35% to 6.04 ± 0.32%, p = 0.33). EPC population, nitrite, VCAM-1, and TBARS levels improved significantly in olmesartan group as compared with placebo ( p ≤ 0.05). Olmesartan significantly decreased ASDAS, BASDAI, BASFI, ESR, CRP, IL-6, TNF-α, and SCORE as compared with placebo. HAQDI and SF-36 (PH) scores improved significantly in olmesartan group as compared with placebo. Olmesartan reduces inflammatory disease activity, improves quality of life (QOL), and decreases CV risk demonstrating the immunomodulatory, vasculoprotective, and cardioprotective potential of this drug in AS.
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