Cardiovascular Risk Management in Ankylosing Spondylitis
Cardiovascular Risk Management in Ankylosing Spondylitis
In total, 254 consecutive AS patients were included (Table 1). The median age of the total AS population was 42 years (IQR 35–51), and 170 patients (67%) were male. Median disease duration was 7 years (IQR 2–14), median CRP was 8 mg/l (IQR 3–25) and mean BASDAI score was 5.9 ± 1.9. One-hundred-and-eighty patients (71%) used NSAIDs. SBP and DPB levels did not significantly differ between patients using NSAIDs (mean SBP/DBP 126/80 mmHg) and not using NSAIDs (mean SBP/DBP 131/82 mmHg), p = 0.4 and p = 0.9 respectively. However, patients who used NSAIDs, as compared to those who did not, significantly more often used antihypertensive medication (26% vs. 9%, p = 0.003).
Of 254 AS patients, eight patients (3%) had a history of CVD and five patients (2%) were diagnosed with type 2 DM. One-hundred-and-nine patients (43%) smoked (45% of the men and 38% of the women) compared to 27% of the general Dutch population (30% of the men and 24% of the women) p = 0.001. Mean BMI was 26.2 ± 4.6, 134 patients (53%) were overweight and 44 patients (17%) were obese. Hypertension was present in 103 AS patients (41%) versus 31% in the general population (p = 0.026). Hypercholesterolemia was present in 30 patients (12%). The results for hypertension, hypercholesterolemia and overweight are displayed categorized by age and gender in Figure 1. Compared to the general Dutch population, the prevalences of hypertension and smoking are higher in AS patients, the latter, however, only in AS males.
(Enlarge Image)
Figure 1.
Prevalences of hypertension (A), overweight (B) and hypercholesterolemia (C) in AS patients compared to the general Dutch population in four different age categories. Legend: X-axis: age categories, Y-axis: percentage, black: ankylosing spondylitis population, grey: general Dutch population.
Out of 254 patients, CV risk according to the Dutch CV-RM guidelines could be assessed in 130 patients (Table 2). One-hundred-and-eight patients were excluded as they were younger than 40 years, eight patients due to a history of CVD, and eight patients due to lack of cholesterol or blood pressure data. According to the Dutch CV-RM guidelines, nine patients (7%) were at high CV risk, sixteen patients (12%) were at intermediate CV risk and 105 patients (81%) were at low CV risk. When adding 15 years to the age of AS patients, CV risk could be assessed in 231 AS patients (excluding seven patients due to age below 40 years, eight patients due to CVD history, eight patients due to lack of data). The percentage of high CV risk patients increased to 26% (Table 3). For the European and American guidelines the percentage of patients at high CV risk was 22% and 29%, respectively.
According to the Dutch CV-RM guidelines, of the 130 screened AS patients, nine patients (7%) were not treated at all while there was an indication for primary CV risk prevention treatment and 22 patients (17%) were inadequately treated, as treatment targets for blood pressure or cholesterol levels were not reached (Table 2). Of the eight patients with a history of CVD, all received secondary prevention treatment, however, treatment targets were not reached in any of them.
In total, of the 138 AS assessed patients, 51 patients had an indication for CV risk treatment of which 42 patients (82%) received some form of CV risk medication (Figure 2). However, 39 (76%) of the 51 patients were treated inadequately due to failure to reach treatment targets for hypertension or hypercholesterolemia or due to total lack of CV risk medication (Table 2). When the modification factor (adding 15 years) was applied, undertreatment of CV risk management was present in 44% of all patients.
(Enlarge Image)
Figure 2.
The identification of AS patients at increased CV risk. Legend: AS; ankylosing spondylitis, CV; cardiovascular, CVD; cardiovascular disease, n; number of patients. Cardiovascular risk treatment is according to the Dutch cardiovascular risk management guideline. Inadequately treated: not treated with statins and/or antihypertensive medication while there was an indication for primary or secondary CV risk prevention treatment not meeting treatment goals.
Results
Basic Demographics and Disease Characteristics
In total, 254 consecutive AS patients were included (Table 1). The median age of the total AS population was 42 years (IQR 35–51), and 170 patients (67%) were male. Median disease duration was 7 years (IQR 2–14), median CRP was 8 mg/l (IQR 3–25) and mean BASDAI score was 5.9 ± 1.9. One-hundred-and-eighty patients (71%) used NSAIDs. SBP and DPB levels did not significantly differ between patients using NSAIDs (mean SBP/DBP 126/80 mmHg) and not using NSAIDs (mean SBP/DBP 131/82 mmHg), p = 0.4 and p = 0.9 respectively. However, patients who used NSAIDs, as compared to those who did not, significantly more often used antihypertensive medication (26% vs. 9%, p = 0.003).
Prevalence of CV Risk Factors
Of 254 AS patients, eight patients (3%) had a history of CVD and five patients (2%) were diagnosed with type 2 DM. One-hundred-and-nine patients (43%) smoked (45% of the men and 38% of the women) compared to 27% of the general Dutch population (30% of the men and 24% of the women) p = 0.001. Mean BMI was 26.2 ± 4.6, 134 patients (53%) were overweight and 44 patients (17%) were obese. Hypertension was present in 103 AS patients (41%) versus 31% in the general population (p = 0.026). Hypercholesterolemia was present in 30 patients (12%). The results for hypertension, hypercholesterolemia and overweight are displayed categorized by age and gender in Figure 1. Compared to the general Dutch population, the prevalences of hypertension and smoking are higher in AS patients, the latter, however, only in AS males.
(Enlarge Image)
Figure 1.
Prevalences of hypertension (A), overweight (B) and hypercholesterolemia (C) in AS patients compared to the general Dutch population in four different age categories. Legend: X-axis: age categories, Y-axis: percentage, black: ankylosing spondylitis population, grey: general Dutch population.
CV Risk Assessment
Out of 254 patients, CV risk according to the Dutch CV-RM guidelines could be assessed in 130 patients (Table 2). One-hundred-and-eight patients were excluded as they were younger than 40 years, eight patients due to a history of CVD, and eight patients due to lack of cholesterol or blood pressure data. According to the Dutch CV-RM guidelines, nine patients (7%) were at high CV risk, sixteen patients (12%) were at intermediate CV risk and 105 patients (81%) were at low CV risk. When adding 15 years to the age of AS patients, CV risk could be assessed in 231 AS patients (excluding seven patients due to age below 40 years, eight patients due to CVD history, eight patients due to lack of data). The percentage of high CV risk patients increased to 26% (Table 3). For the European and American guidelines the percentage of patients at high CV risk was 22% and 29%, respectively.
CV Risk Management
According to the Dutch CV-RM guidelines, of the 130 screened AS patients, nine patients (7%) were not treated at all while there was an indication for primary CV risk prevention treatment and 22 patients (17%) were inadequately treated, as treatment targets for blood pressure or cholesterol levels were not reached (Table 2). Of the eight patients with a history of CVD, all received secondary prevention treatment, however, treatment targets were not reached in any of them.
In total, of the 138 AS assessed patients, 51 patients had an indication for CV risk treatment of which 42 patients (82%) received some form of CV risk medication (Figure 2). However, 39 (76%) of the 51 patients were treated inadequately due to failure to reach treatment targets for hypertension or hypercholesterolemia or due to total lack of CV risk medication (Table 2). When the modification factor (adding 15 years) was applied, undertreatment of CV risk management was present in 44% of all patients.
(Enlarge Image)
Figure 2.
The identification of AS patients at increased CV risk. Legend: AS; ankylosing spondylitis, CV; cardiovascular, CVD; cardiovascular disease, n; number of patients. Cardiovascular risk treatment is according to the Dutch cardiovascular risk management guideline. Inadequately treated: not treated with statins and/or antihypertensive medication while there was an indication for primary or secondary CV risk prevention treatment not meeting treatment goals.
Source...