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Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study.
Arthritis Res Ther. 2017 05 18; 19(1):102.AR

Abstract

BACKGROUND

To investigate the risk of first-time acute coronary syndrome (ACS), stroke and venous thromboembolism (VTE) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated spondyloarthritis (uSpA), compared to each other and to the general population (GP).

METHODS

This is a prospective nationwide cohort study. Cohorts with AS (n = 6448), PsA (n = 16,063) and uSpA (n = 5190) patients and a GP (n = 266,435) cohort, were identified 2001-2009 in the Swedish National Patient and Population registers. The follow-up began 1 January 2006, or 6 months after the first registered spondyloarthritis (SpA) diagnosis thereafter, and ended at ACS/stroke/VTE event, death, emigration or 31 December 2012. Crude and age- and sex-standardized incidence rates (SIRs) and hazard ratios (HRs) were calculated for incident ACS, stroke or VTE, respectively.

RESULTS

Standardized to the GP cohort, SIRs for ACS were 4.3, 5.4 and 4.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort, respectively, compared to 3.2 in the GP cohort. SIRs for stroke were 5.4, 5.9 and 5.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort compared to 4.7 in the GP cohort. Corresponding SIRs for VTE were 3.6, 3.2 and 3.5 events per 1000 person-years at risk compared to 2.2 in the GP cohort. Age-and sex-adjusted HRs (95% CI) for ACS events were significantly increased in AS (1.54 (1.31-1.82)), PsA (1.76 (1.59-1.95)) and uSpA (1.36 (1.05-1.76)) compared to GP. Age-adjusted HRs for ACS was significantly decreased in female AS patients (0.59 (0.37-0.97)) compared to female PsA patients. Age-and sex-adjusted HRs for stroke events were significantly increased in AS (1.25 (1.06-1.48)) and PsA (1.34 (1.22-1.48)), and nonsignificantly increased in uSpA (1.16 (0.91-1.47)) compared to GP. For VTE the age-and sex-adjusted HRs for AS, PsA and uSpA were equally and significantly increased with about 50% compared to GP.

CONCLUSIONS

Patients with AS, PsA and uSpA are at increased risk for ACS and stroke events, which emphasizes the importance of identification of and intervention against cardiovascular risk factors in SpA patients. Increased alertness for VTE is warranted in patients with SpA.

Authors+Show Affiliations

Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden. karin.si.bengtsson@vgregion.se.Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden. Departments of Public Health and Clinical Medicine, Rheumatology, Umeå University, 901 87, Umeå, Sweden.Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, 202 13, Malmö, Sweden.Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.Clinical Epidemiology Unit and Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, 171 77, Solna, Sweden.Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28521824

Citation

Bengtsson, Karin, et al. "Are Ankylosing Spondylitis, Psoriatic Arthritis and Undifferentiated Spondyloarthritis Associated With an Increased Risk of Cardiovascular Events? a Prospective Nationwide Population-based Cohort Study." Arthritis Research & Therapy, vol. 19, no. 1, 2017, p. 102.
Bengtsson K, Forsblad-d'Elia H, Lie E, et al. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017;19(1):102.
Bengtsson, K., Forsblad-d'Elia, H., Lie, E., Klingberg, E., Dehlin, M., Exarchou, S., Lindström, U., Askling, J., & Jacobsson, L. T. H. (2017). Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Research & Therapy, 19(1), 102. https://doi.org/10.1186/s13075-017-1315-z
Bengtsson K, et al. Are Ankylosing Spondylitis, Psoriatic Arthritis and Undifferentiated Spondyloarthritis Associated With an Increased Risk of Cardiovascular Events? a Prospective Nationwide Population-based Cohort Study. Arthritis Res Ther. 2017 05 18;19(1):102. PubMed PMID: 28521824.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. AU - Bengtsson,Karin, AU - Forsblad-d'Elia,Helena, AU - Lie,Elisabeth, AU - Klingberg,Eva, AU - Dehlin,Mats, AU - Exarchou,Sofia, AU - Lindström,Ulf, AU - Askling,Johan, AU - Jacobsson,Lennart T H, Y1 - 2017/05/18/ PY - 2017/02/07/received PY - 2017/05/02/accepted PY - 2017/5/20/entrez PY - 2017/5/20/pubmed PY - 2018/3/9/medline KW - Acute coronary syndrome KW - Ankylosing spondylitis KW - Cardiovascular disease KW - Cohort KW - Psoriatic arthritis KW - Spondylarthropathies KW - Spondyloarthritis KW - Stroke KW - Undifferentiated spondyloarthritis KW - Venous thromboembolism SP - 102 EP - 102 JF - Arthritis research & therapy JO - Arthritis Res. Ther. VL - 19 IS - 1 N2 - BACKGROUND: To investigate the risk of first-time acute coronary syndrome (ACS), stroke and venous thromboembolism (VTE) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated spondyloarthritis (uSpA), compared to each other and to the general population (GP). METHODS: This is a prospective nationwide cohort study. Cohorts with AS (n = 6448), PsA (n = 16,063) and uSpA (n = 5190) patients and a GP (n = 266,435) cohort, were identified 2001-2009 in the Swedish National Patient and Population registers. The follow-up began 1 January 2006, or 6 months after the first registered spondyloarthritis (SpA) diagnosis thereafter, and ended at ACS/stroke/VTE event, death, emigration or 31 December 2012. Crude and age- and sex-standardized incidence rates (SIRs) and hazard ratios (HRs) were calculated for incident ACS, stroke or VTE, respectively. RESULTS: Standardized to the GP cohort, SIRs for ACS were 4.3, 5.4 and 4.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort, respectively, compared to 3.2 in the GP cohort. SIRs for stroke were 5.4, 5.9 and 5.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort compared to 4.7 in the GP cohort. Corresponding SIRs for VTE were 3.6, 3.2 and 3.5 events per 1000 person-years at risk compared to 2.2 in the GP cohort. Age-and sex-adjusted HRs (95% CI) for ACS events were significantly increased in AS (1.54 (1.31-1.82)), PsA (1.76 (1.59-1.95)) and uSpA (1.36 (1.05-1.76)) compared to GP. Age-adjusted HRs for ACS was significantly decreased in female AS patients (0.59 (0.37-0.97)) compared to female PsA patients. Age-and sex-adjusted HRs for stroke events were significantly increased in AS (1.25 (1.06-1.48)) and PsA (1.34 (1.22-1.48)), and nonsignificantly increased in uSpA (1.16 (0.91-1.47)) compared to GP. For VTE the age-and sex-adjusted HRs for AS, PsA and uSpA were equally and significantly increased with about 50% compared to GP. CONCLUSIONS: Patients with AS, PsA and uSpA are at increased risk for ACS and stroke events, which emphasizes the importance of identification of and intervention against cardiovascular risk factors in SpA patients. Increased alertness for VTE is warranted in patients with SpA. SN - 1478-6362 UR - https://www.unboundmedicine.com/medline/citation/28521824/Are_ankylosing_spondylitis_psoriatic_arthritis_and_undifferentiated_spondyloarthritis_associated_with_an_increased_risk_of_cardiovascular_events_A_prospective_nationwide_population_based_cohort_study_ L2 - https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-017-1315-z DB - PRIME DP - Unbound Medicine ER -