Ankylosing Spondylitis and Cardiovascular Mortality

Study Questions:

What is the association between ankylosing spondylitis (AS) and excess cardiovascular and cerebrovascular morbidity?


This was a population-based retrospective cohort study using administrative health data in Ontario, Canada. A total of 21,473 patients with AS aged 15 years or older and 86,606 comparators without AS matched for age, sex, and location of residence were analyzed. The primary outcome was a composite of cardiovascular and cerebrovascular death. Hazard ratios (HRs) for vascular death were calculated; adjusted for history of cancer, diabetes, dementia, inflammatory bowel disease, hypertension, chronic kidney disease, and peripheral vascular disease; and, among those aged 66 years or older, relevant drug therapies. Independent risk factors for vascular mortality were identified in patients with AS.


The mean age of patients with AS was 46 years, and 53% were male. Patients and comparators were followed for 166,920 and 686,461 patient-years, respectively. Adjusted HRs for vascular death in AS were 1.36 (95% confidence interval [CI], 1.13-1.65) overall, 1.46 (95% CI, 1.13-1.87) in men, and 1.24 (95% CI, 0.92-1.67) in women. Significant risk factors for vascular death were age; male sex; lower income; dementia; chronic kidney disease; peripheral vascular disease; and, among patients aged 65 years or older, lack of exposure to nonsteroidal anti-inflammatory drugs and statins.


The authors concluded that AS is associated with increased risk for vascular mortality.


This study reports that patients with AS had a significantly higher risk for vascular death than those without AS. Furthermore, these results remained significant after multiple other baseline factors were also controlled for, including drug therapy in a subset of patients. Additional studies are indicated on the effect of therapeutic interventions and optimal control of inflammation in preventing the enhanced vascular mortality in patients with AS and other inflammatory arthritis. Based on these findings, a comprehensive strategy is needed to screen and treat modifiable risk factors for vascular disease in patients with AS.

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins, Hypertension, Sleep Apnea

Keywords: Arthritis, Dementia, Diabetes Mellitus, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Neoplasms, Peripheral Vascular Diseases, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Risk, Spondylitis, Ankylosing, Vascular Diseases

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