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GUEST EDITORIAL
Year : 2019  |  Volume : 12  |  Issue : 5  |  Page : 385-386  

Is ankylosing spondylitis a risk factor for subclinical atherosclerosis? The debate is going on


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 Publication19-Sep-2019

Correspondence Address:
A K M Monwarul Islam
Department of Cardiology, National Institute of Cardiovascular Diseases, Sher e Bangla Nagar, Dhaka 1207
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_134_18

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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 2019 Oct 22];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.[1] However, other studies did not find a positive association between AS and subclinical atherosclerosis.[2],[3]

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).[4] 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.[5] The observations correlate with those of 1 recently published study involving nonIndian population [6] and one meta-analysis involving 24 studies.[7] A study by Ozdowska et al.[6] 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).[7]

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.



 
  References Top

1.
Gonzalez-Juanatey C, Vazquez-Rodriguez TR, Miranda-Filloy JA, Dierssen T, Vaqueiro I, Blanco R, et al. The high prevalence of subclinical atherosclerosis in patients with ankylosing spondylitis without clinically evident cardiovascular disease. Medicine (Baltimore) 2009;88:358-65.  Back to cited text no. 1
    
2.
Valente RL, Valente JM, de Castro GR, Zimmermann AF, Fialho SC, Pereira IA, et al. Subclinical atherosclerosis in ankylosing spondylitis: Is there a role for inflammation? Rev Bras Reumatol 2013;53:377-81.  Back to cited text no. 2
    
3.
Arida A, Protogerou AD, Konstantonis G, Konsta M, Delicha EM, Kitas GD, et al. Subclinical atherosclerosis is not accelerated in patients with ankylosing spondylitis with low disease activity: New data and metaanalysis of published studies. J Rheumatol 2015;42:2098-105.  Back to cited text no. 3
    
4.
Verma I, Krishan P, Syngle A. Predictors of atherosclerosis in ankylosing spondylitis. Rheumatol Ther 2015;2:173-82.  Back to cited text no. 4
    
5.
Sharma SK, Prasad KT, Handa R, Sharma SK. Increased prevalence of subclinical atherosclerosis in ankylosing spondylitis. Indian J Rheumatol 2015;10:53-7.  Back to cited text no. 5
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6.
Ozdowska P, Wardziak Ł, Kruk M, Kępka C, Kowalik I, Szwed H, et al. Increased prevalence of subclinical coronary atherosclerosis in young patients with ankylosing spondylitis. Pol Arch Intern Med 2018;128:455-61.  Back to cited text no. 6
    
7.
Yuan Y, Yang J, Zhang X, Han R, Chen M, Hu X, et al. Carotid intima-media thickness in patients with ankylosing spondylitis: A systematic review and updated meta-analysis. J Atheroscler Thromb 2018. doi: 10.5551/jat.45294. [Epub ahead of print].  Back to cited text no. 7
    




 

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