Berg Inger Jorid, van der Heijde Désirée, Dagfinrud Hanne, Seljeflot Ingebjørg, Olsen Inge Christoffer, Kvien Tore K, Semb Anne Grete, Provan Sella A
From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo.
J Rheumatol. 2015 Apr;42(4):645-53. doi: 10.3899/jrheum.141018. Epub 2015 Feb 1.
To compare the risk of cardiovascular disease (CVD) in ankylosing spondylitis (AS) and population controls, and to examine the associations between disease activity and CVD risk.
A cross-sectional study was done of patients with AS grouped according to Ankylosing Spondylitis Disease Activity Score (ASDAS) into ASDAS-high and ASDAS-low. Markers of vascular pathology, impaired endothelial function [asymmetric dimethylarginine (ADMA)], and arterial stiffness [augmentation index (AIx) and pulse wave velocity (PWV)], and traditional CVD risk factors [blood pressure, lipids, body mass index (BMI), CVD risk scores] were compared between AS and controls as well as across ASDAS-high versus ASDAS-low versus controls using ANCOVA analyses.
Altogether, 151 patients with AS and 134 controls participated. Patients had elevated ADMA (µmol/l) and AIx (%) compared to controls: mean difference (95% CI): 0.05 (0.03, 0.07), p < 0.001 and 2.6 (0.8, 4.3), p = 0.01, respectively. AIx increased with higher ASDAS level, p(trend) < 0.04. There were no significant group differences of PWV. BMI was higher in ASDAS-high compared to ASDAS-low (p = 0.02). Total cholesterol was lower in AS compared to controls, and lower with higher ASDAS, p(trend) = 0.02. CVD risk scores were similar across groups except for Reynolds Risk Score, where the ASDAS-high group had a significantly higher score, compared to both ASDAS-low and controls.
Elevated ADMA and AIx in AS support a higher CVD risk in AS. Elevated AIx and BMI in AS with high ASDAS indicate an association between disease activity and CVD risk. Lower total cholesterol in AS may contribute to underestimation of CVD risk.
比较强直性脊柱炎（AS）患者与普通人群心血管疾病（CVD）的风险，并研究疾病活动度与CVD风险之间的关联。
开展一项横断面研究，将AS患者根据强直性脊柱炎疾病活动度评分（ASDAS）分为ASDAS高分组和ASDAS低分组。比较AS患者与对照组之间以及ASDAS高分组、ASDAS低分组与对照组之间血管病理学标志物、内皮功能受损指标[不对称二甲基精氨酸（ADMA）]、动脉僵硬度指标[增强指数（AIx）和脉搏波速度（PWV）]以及传统CVD风险因素[血压、血脂、体重指数（BMI）、CVD风险评分]，采用协方差分析。
共有151例AS患者和134例对照参与研究。与对照组相比，患者的ADMA（μmol/L）和AIx（%）升高：平均差异（95%CI）分别为0.05（0.03，0.07），p<0.001和2.6（0.8，4.3），p = 0.01。AIx随ASDAS水平升高而增加，p（趋势）<0.04。PWV在各组间无显著差异。ASDAS高分组的BMI高于ASDAS低分组（p = 0.02）。与对照组相比，AS患者的总胆固醇较低，且随ASDAS升高而降低，p（趋势）= 0.02。除雷诺兹风险评分外，各组间的CVD风险评分相似，ASDAS高分组的雷诺兹风险评分显著高于ASDAS低分组和对照组。
AS患者ADMA和AIx升高表明AS患者的CVD风险更高。ASDAS高的AS患者中AIx和BMI升高表明疾病活动度与CVD风险之间存在关联。AS患者总胆固醇较低可能导致对CVD风险的低估。
