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Progression of subclinical atherosclerosis in ankylosing spondylitis: a 10-year prospective study

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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.

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Data availability

The data that support the findings of this study are available on request from the corresponding author [AA].

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Funding

The research was supported by the Special Account for Research Grants (SARG) of the National and Kapodistrian University of Athens.

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Authors and Affiliations

  1. First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Agiou Thoma 17, 11527, Athens, Greece

    Aikaterini Arida, George E. Fragoulis, George Konstantonis, Maria Tektonidou & Petros P. Sfikakis

  2. First Department of Cardiology Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Dimitrios Terentes-Printzios & Charalambos Vlachopoulos

  3. Cardiovascular Prevention and Research Unit, Clinic and Laboratory of Pathophysiology, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Athanasios D. Protogerou

Authors
  1. Aikaterini Arida
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Contributions

All authors met the ICMJE 4 authorship criteria: AA, DTP, ADP, CV, MT AND PP contributed to the conception and design of the work, AA, GK, ADP, MT and PP contributed to the acquisition of the data, AA and GK to the analysis of the data and all authors contributed to the interpretation of the data. AA, GE, MT and PP contributed to the drafting of the work and all authors to reviewing it critically for important intellectual content. All authors gave final approval of the version to be published and all authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Finally, all authors take full responsibility for all aspects of the work.

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Correspondence to Aikaterini Arida.

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Arida, A., Fragoulis, G.E., Terentes-Printzios, D. et al. Progression of subclinical atherosclerosis in ankylosing spondylitis: a 10-year prospective study. Rheumatol Int 44, 643–652 (2024). https://doi.org/10.1007/s00296-023-05528-7

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