Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Myocardial Infarction and Cardiovascular Risk Profile in Ankylosing Spondylitis. A Systematic Review and Meta-Analysis.
Mathieu3, Sylvain, Gossec2, Laure, Dougados1, Maxime, Soubrier3, Martin
Rheumatoid arthritis (RA) is associated with increased cardiovascular risk. In ankylosing spondylitis (AS) there is little information on cardiovascular risks, especially that of myocardial infarction (MI) risk.
To assess the incidence of MI and the cardiovascular risk profile in AS patients.
A literature review of publications up to August 2009 was performed using Pubmed, Embase, the Cochrane Collaboration and congress abstracts. All observational studies reporting MI and all case/control studies assessing traditional (blood pressure, glycemia, metabolic syndrome, body mass index (BMI), lipid profile) and newer cardiovascular risk factors (intima-media thickness (IMT)) in AS patients and healthy controls were included. Myocardial infarction risks were calculated by metaproportion (inverse of the variance method) and for 100 patient-years (pyrs) of exposure. To assess the MI risk in AS, a meta-analysis was performed using Mantel-Haenszel's method. For continuous variables, the differences between AS patients and controls were expressed by standardized mean difference using inverse of variance method.
Eight longitudinal studies were included (N patients=3279). In control groups (N=82735), 1318 MI were observed (4.6 % (95%CI [0.01, 0.10])). A total of 224 MI were reported in the 3279 AS patients during a mean follow-up of 22 years. In AS patients, the incidence of MI was about 7.0 % (95% CI [0.05, 0.10]) i.e, 0.35/100 pyrs. Meta-analysis of the three longitudinal studies comparing occurrence of MI in AS patients (146/2266) and healthy controls (1318/82745) showed no significant increase in MI in AS patients: risk ratio = 1.88 (0.834.28). Fifteen case/control studies and nine abstracts were included (N patients=1214 and N controls=1000). AS patients were characterized by a higher weighted mean intima-media thickness (0.61±0.12 vs. 0.54±0.10 mm; p=0.008), a significant decrease in levels of triglycerides, of total cholesterol and of HDL cholesterol compared with healthy controls. The risk of metabolic syndrome was higher in AS patients: RR= 2.13 (95% CI [1.46, 3.06]), but without differences in level of glycemia or in BMI. No difference was evidenced in blood pressure, levels of homocysteinemia, of LDL cholesterol and atherogenic index (total cholesterol/HDL cholesterol).
AS patients appear at higher risk of MI compared to controls. This could be due to an atherogenic lipid profile or to systemic inflammation. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS.
To cite this abstract, please use the following information:
Mathieu, Sylvain, Gossec, Laure, Dougados, Maxime, Soubrier, Martin; Myocardial Infarction and Cardiovascular Risk Profile in Ankylosing Spondylitis. A Systematic Review and Meta-Analysis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :542