Related Experiment Video
Updated: Jul 3, 2025
Author Spotlight: Evaluating Traditional Chinese Therapy for Ankylosing Spondylitis in Mice
Published on: October 27, 2023
Progression of subclinical atherosclerosis in ankylosing spondylitis: a 10-year prospective study
Aikaterini Arida1, George E Fragoulis2, Dimitrios Terentes-Printzios3
1First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Agiou Thoma 17, 11527, Athens, Greece. aridakater@yahoo.gr.
Insights
Ankylosing Spondylitis patients show accelerated atherosclerosis progression linked to disease activity, not just traditional risk factors. Better management of cardiovascular disease risk factors is crucial for these patients.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Immunology
Background:
- Chronic systemic inflammation in Ankylosing Spondylitis (AS) increases cardiovascular disease (CVD) risk.
- Long-term data on subclinical atherosclerosis progression in AS patients are limited.
Purpose of the Study:
- To investigate the 10-year progression of subclinical atherosclerosis in contemporary AS patients.
- To identify factors associated with atherosclerosis acceleration in AS.
Main Methods:
- Prospective evaluation of 53 AS patients and 53 controls over ~10 years.
- Assessment of carotid/femoral atheromatosis, pulse wave velocity (PWV), and intima-media thickness (IMT) via ultrasonography.
- Multivariate analysis correlating atherosclerosis progression with CVD risk factors and AS disease activity (BASDAI).
Main Results:
- Atherosclerosis progression in the general population was linked solely to classical CVD risk factors (heartSCORE).
- In AS patients, progression was associated with higher BASDAI scores, independent of biologic therapies.
- Baseline PWV predicted plaque progression in AS patients, considering heartSCORE and plaque burden.
- AS patients showed poorer CVD risk factor control at follow-up compared to controls.
Conclusions:
- Both classical CVD risk factors and residual AS disease activity contribute to subclinical atherosclerosis progression.
- Contemporary AS management requires addressing unmet needs in cardiovascular risk reduction.
- Early detection and management of atherosclerosis progression are vital in AS patients.
Abstract:
Chronic systemic inflammation contributes to increased CVD burden in Ankylosing Spondylitis (AS). Since long-term follow-up data on subclinical atherosclerosis acceleration are lacking, we examined its progression in contemporary AS patients during 10 years. Fifty-three (89% male, aged 50.4 (36.3-55.9) years,) non-diabetic, CVD-free AS patients and 53 age-sex-matched non-diabetic, control individuals were re-evaluated after 9.2-10.2 years by ultrasonography for carotid/femoral atheromatosis, pulse wave velocity (PWV) and intima-media thickness (IMT), performed by the same operator/protocol. New atheromatic plaque formation, PWV deterioration, and IMT increase were associated only with classical CVD risk factors, as reflected by the heartSCORE (age, gender, smoking status, blood pressure and cholesterol levels) by multivariate analysis, rather than disease presence. However, among AS patients, despite remission/low disease activity at follow-up end in 79%, atheromatosis progression was associated by multivariate analysis with higher BASDAI scores (p = 0.028), independently of biologic therapies administered in 2/3 of them. Moreover, in AS patients, but not in controls, PWV values at baseline were associated with plaque progression during the 10-year follow-up after taking into account baseline heartSCORE and plaque burden status (p = 0.033). Despite comparable prevalence of both hypertension and hypercholesterolemia at baseline between patients and controls, a lower percentage of AS patients had achieved "adequate" CVD risk factor control at follow-up end (11% vs 25% respectively, p = 0.076). Classical CVD risk factors and residual disease activity account for the progression of subclinical atherosclerosis in AS, pointing to the unmet needs in the contemporary management of these patients.
