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Ischemic heart disease and ankylosing spondylitis—assessing the role of inflammation

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Abstract

To assess the association of ankylosing spondylitis (AS) and ischemic heart disease (IHD) compared to traditional cardiovascular (CV) risk factors. Primary care and hospital records of patients with AS were analyzed, using the largest health maintenance organization in Israel, the “Clalit” Health Services data. These patients were compared with age- and gender-matched controls regarding the proportion of IHD in a cross-sectional study. Parameters including socioeconomic status, body mass index (BMI), smoking habits, and coexistent medical conditions hypertension, hyperlipidemia, and diabetes mellitus (DM) - as well as the use of NSAIDs and anti-TNFs were also assessed. The study included 4076 AS patients compared to 20,290 age- and gender-matched controls without AS. The proportion of IHD was higher among AS patients as compared to controls (14.1 vs. 6.36%, respectively, p < 0.01) and patients treated with anti-TNFs had a lower risk for IHD compared to non-anti-TNF users. The proportion of hypertension, hyperlipidemia, DM, and smoking was also higher among AS patients. However, in multivariate analyses following adjustment to these risk factors, AS was not found to be associated with IHD nor anti-TNF therapy to be a protective factor. Patients with AS have more traditional CV risk factors, thus are in a higher risk for IHD. AS itself was not shown to be independently associated with IHD. These findings emphasize the multifactorial process leading to increased proportion of IHD among AS patients and the need for a stringent control of traditional risk factors in these patients.

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Author information

Author notes

  1. Michal Vinker Shuster and Omer Gendelman are the first authors who share equal contribution.

  2. Arnon D. Cohen and Howard Amital are the last two authors who share equal contribution.

Authors and Affiliations

  1. The Hebrew University of Jerusalem, Jerusalem, Israel

    Michal Vinker Shuster

  2. Hadassah Hebrew University Medical Center, Jerusalem, Israel

    Michal Vinker Shuster

  3. Department of Medicine ‘B’, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, 5262100, Ramat-Gan, Israel

    Omer Gendelman, Shmuel Tiosano & Howard Amital

  4. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Omer Gendelman, Shmuel Tiosano & Howard Amital

  5. Chief Physician’s Office, Clalit Health Services, Tel Aviv, Israel

    Doron Comaneshter & Arnon D. Cohen

  6. Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Arnon D. Cohen

Authors
  1. Michal Vinker Shuster
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  2. Omer Gendelman
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  3. Shmuel Tiosano
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  4. Doron Comaneshter
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  5. Arnon D. Cohen
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  6. Howard Amital
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Corresponding author

Correspondence to Howard Amital.

Ethics declarations

The study was approved by the ethics committee of CHS, located in the Soroka Medical Center, Beer-Sheva, Israel.

Conflict of interest

Prof. Arnon Cohen: Relationships relevant to this manuscript: Prof. Arnon Cohen received research grants from Janssen, Novartis, AbbVie and Sanofi. Other relationships: In the last 3 years, Prof. Arnon Cohen served as a consultant, advisor or speaker to AbbVie; Amgen; Boehringer Ingelheim; Dexcel pharma; Janssen; Kamedis; Lilly; Neopharm; Novartis; Perrigo; Pfizer, Rafa, Sanofi, Sirbal; Taro. All other authors declares no conflict of interest.

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Vinker Shuster, M., Gendelman, O., Tiosano, S. et al. Ischemic heart disease and ankylosing spondylitis—assessing the role of inflammation. Clin Rheumatol 37, 1053–1058 (2018). https://doi.org/10.1007/s10067-018-4037-y

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  • DOI: https://doi.org/10.1007/s10067-018-4037-y

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