|Year : 2019 | Volume
| Issue : 5 | Page : 385-386
Is ankylosing spondylitis a risk factor for subclinical atherosclerosis? The debate is going on
A K M Monwarul Islam1, A K M Mohibullah2
1 Department of Cardiology, National Institute of Cardiovascular Disease, Bangladesh
2 Department of Cardiology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Hospital, Bangladesh and President, Bangladesh Cardiac Society, Bangladesh
|Date of Web Publication||19-Sep-2019|
A K M Monwarul Islam
Department of Cardiology, National Institute of Cardiovascular Diseases, Sher e Bangla Nagar, Dhaka 1207
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Monwarul Islam A K, Mohibullah A K. Is ankylosing spondylitis a risk factor for subclinical atherosclerosis? The debate is going on. Med J DY Patil Vidyapeeth 2019;12:385-6
|How to cite this URL:|
Monwarul Islam A K, Mohibullah A K. Is ankylosing spondylitis a risk factor for subclinical atherosclerosis? The debate is going on. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2020 Feb 28];12:385-6. Available from: http://www.mjdrdypv.org/text.asp?2019/12/5/385/267074
Ankylosing spondylitis (AS) is a spondyloarthropathy which primarily involves the axial skeleton but also affects the peripheral joints and extra-articular structures, including the cardiovascular system. Ascending aortitis, aortic regurgitation, atrioventricular block and bundle branch block are the well known cardiovascular manifestations. Studies have demonstrated an excess atherosclerotic cardiovascular disease in AS, manifesting as ischemic heart disease, cerebrovascular disease, or peripheral arterial disease. However, the association between AS and subclinical atherosclerosis is a matter of ongoing debate. For the detection of subclinical atherosclerosis, some imaging techniques are available such as the carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) of brachial artery, ankle-brachial index (ABI), coronary artery calcium score, and positron emission tomography. Among these, CIMT and FMD of brachial artery have most commonly been used to study the link between AS and subclinical atherosclerosis. Most of the studies carried out so far are observational, cross-sectional studies with relatively small sample size. Results of a study involving 64 AS patients from Spain show that patients with AS without clinically evident cardiovascular disease have a high prevalence of subclinical macrovascular disease. However, other studies did not find a positive association between AS and subclinical atherosclerosis.,
South Asian people are unduly prone to atherosclerosis, and classical risk factors of atherosclerosis are also prevalent here. The data generated in other population in relation to AS and subclinical atherosclerosis may not be readily extrapolated to the South Asian population. Studies carried out in India so far have in general demonstrated increased prevalence of subclinical atherosclerosis in Indian AS patients. A prospective study from Punjab showed increased CIMT in AS patients without traditional cardiovascular risk factors (0.62 ± 0.12 mm vs. 0.53 ± 0.09 mm, P = 0.006). Another study from the All India Institute of Medical Sciences, New Delhi using CIMT, FMD of the brachial artery and ABI found increased prevalence of subclinical atherosclerosis in AS patients. The observations correlate with those of 1 recently published study involving nonIndian population  and one meta-analysis involving 24 studies. A study by Ozdowska et al. found increased prevalence of subclinical atherosclerosis in young patients with AS assessed by coronary computed tomography angiography. The systematic review concluded that CIMT was significantly increased in patients with AS compared with healthy controls (standardized mean differences = 0.725, 95% confidence interval = 0.443–1.008, P < 0.001).
Well-designed, large-scale studies are needed to further elucidate the relationship between AS and subclinical atherosclerosis, especially in relation to varying disease activity and different modalities of treatment in the South Asian context.
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