Cardiovascular Risk Deserves Attention Among Patients With AxSpA

Rheumatologist management of patients with axial spondyloarthritis (axSpA) should include assessment of cardiovascular risk, according to a systematic review published online in Clinical Rheumatology.

“Cardiovascular disease is a frequent comorbidity in axSpA patients, and patients with axSpA have a higher mortality because of cardiovascular disease, which is the most frequent cause [of death] followed by malignant diseases,” wrote a research team from Austria.

Among the 123 studies included in the review, one single-center study with a 32-year follow-up found cardiovascular disease associated with 40% of deaths among 360 patients with axSpA, while malignant disease accounted for 27%, researchers reported. That study also found C-reactive protein, nonsteroidal antirheumatic drugs, and work disability to be independent predictors of mortality in the patient population.

Meanwhile, another prospective study of 6448 patients with axSpA reported overall hazard ratios of 1.54 for acute coronary syndrome, 1.25 for stroke, and 1.53 for venous thromboembolism. Incident venous thromboembolism was more common in female patients, while acute coronary syndrome was more common in male patients, according to the review.

“To some extent, ultrasound of carotid arteries, echocardiography, and coronary CT [computerized tomography] scans can identify patients at risk, similar to medical checkups performed in the general population,” the authors advised, “potentially leading to stricter optimization of modifiable risk factors.”

Lowering axial disease activity is important for reducing cardiovascular disease risk, with the best evidence supporting tumor necrosis factor inhibitors, researchers reported. Rheumatologists should also address traditional risk factors in patients, including hyperlipidemia, hypertension, and smoking.  

“Recognizing patients at risk, especially early in the disease course, offers the possibility of timely intervention and, in turn, reduced cardiovascular morbidity and mortality later in the disease course,” researchers wrote.

Reference
Hintenberger R, Affenzeller B, Vladychuk V, Pieringer H. Cardiovascular risk in axial spondyloarthritis-a systematic review. Clin Rheumatol. Published online July 7, 2023. doi: 10.1007/s10067-023-06655-z