Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Int J Environ Res Public Health. 2022 Mar 30;19(7):4098. doi: 10.3390/ijerph19074098.
Background: Potential risk factors for major adverse cardiovascular events (MACE) in patients with ankylosing spondylitis (AS) requiring medical therapy should be investigated. Methods: We identified newly diagnosed AS patients without previous MACE from 2004 to 2012 using the National Health Insurance Research Database, matched MACE cases with non-MACE controls at a 1:4 ratio for age, gender, AS duration, and index date, and included 947 AS patients with MACE and 3896 matched controls for final analyses. By using conditional logistic regression analyses, we examined the associations of MACE with low income, urbanisation, comorbidities, common extra-articular manifestations (EAM), and medications, including nonsteroidal anti-inflammatory drugs (NSAID) of three categories (traditional NSAIDs, selective cyclooxygenase-2 inhibitors (COX-2i), and preferential COX-2is) with their annual cumulative defined daily dose (cDDD) within a year before MACE development. Results: MACE development was associated with the use of selective COX-2is (especially with annual cDDD > 132) and corticosteroids, residence in rural regions, and well-known associated comorbidities, but not with the use of traditional NSAIDs, preferential COX-2i, biologics, methotrexate, sulfasalazine, and common EAMs. Conclusions: The risk factors of MACE in newly diagnosed AS patients include residence in rural regions, well-known associated comorbidities, and the use of corticosteroids and selective COX-2is. A major limitation was the lack of information on individual lifestyle patterns and disease activity.
需要药物治疗的强直性脊柱炎（AS）患者发生主要不良心血管事件（MACE）的潜在危险因素应加以研究。方法：我们利用全民健康保险研究数据库，从 2004 年至 2012 年中确定了无先前 MACE 事件的新诊断 AS 患者，按照年龄、性别、AS 患病时间和指数日期以 1：4 的比例将 MACE 病例与非 MACE 对照相匹配，最终纳入 947 例 MACE 患者和 3896 例匹配对照进行分析。我们采用条件逻辑回归分析，考察了 MACE 与低收入、城市化、合并症、常见关节外表现（EAM）和药物（包括三类非甾体抗炎药（NSAID），即传统 NSAID、选择性环氧化酶-2 抑制剂（COX-2i）和选择性 COX-2i）之间的相关性，及其在发生 MACE 前一年中各自的年累计标准日剂量（cDDD）。结果：MACE 发生与选择性 COX-2i（尤其是年 cDDD＞132）和皮质激素的使用、居住在农村地区以及已知的相关合并症有关，但与传统 NSAID、选择性 COX-2i、生物制剂、甲氨蝶呤、柳氮磺胺吡啶和常见 EAM 无关。结论：新诊断 AS 患者发生 MACE 的危险因素包括居住在农村地区、已知的相关合并症和皮质激素及选择性 COX-2i 的使用。主要局限性在于缺乏关于个体生活方式和疾病活动的信息。
