Assessment of the relationship between estimated cardiovascular risk and structural damage in patients with axial spondyloarthritis

María Lourdes Ladehesa-Pineda; Iván Arias de la Rosa; Clementina López Medina; María Del Carmen Castro-Villegas; María Del Carmen Ábalos-Aguilera; Rafaela Ortega-Castro; Ignacio Gómez-García; Pedro Seguí-Azpilcueta; Yolanda Jiménez-Gómez; Alejandro Escudero-Contreras; Chary López Pedrera; Nuria Barbarroja; Eduardo Collantes-Estévez; CASTRO Working Group

doi:10.1177/1759720X20982837

Assessment of the relationship between estimated cardiovascular risk and structural damage in patients with axial spondyloarthritis

Ther Adv Musculoskelet Dis. 2020 Dec 30:12:1759720X20982837. doi: 10.1177/1759720X20982837. eCollection 2020.

Authors

María Lourdes Ladehesa-Pineda¹, Iván Arias de la Rosa², Clementina López Medina², María Del Carmen Castro-Villegas², María Del Carmen Ábalos-Aguilera², Rafaela Ortega-Castro², Ignacio Gómez-García², Pedro Seguí-Azpilcueta², Yolanda Jiménez-Gómez², Alejandro Escudero-Contreras², Chary López Pedrera², Nuria Barbarroja², Eduardo Collantes-Estévez²; CASTRO Working Group

Affiliations

¹ Department of Rheumatology of "Reina Sofia University Hospital", Avda. Menéndez Pidal s/n, Córdoba, 14004, Spain.
² Reina Sofia University Hospital/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC)/University of Córdoba, Cordoba, Spain.

Abstract

Aims: To evaluate the association of estimated cardiovascular (CV) risk and subclinical atherosclerosis with radiographic structural damage in patients with axial spondyloarthritis (axSpA).

Methods: Cross-sectional study including 114 patients axSpA from the SpA registry of Córdoba (CASTRO) and 132 age- and sex-matched healthy controls (HCs). Disease activity and the presence of traditional CV risk factors were recorded. The presence of atherosclerotic plaques and carotid intima media thickness (cIMT) were evaluated through carotid ultrasound and the SCORE index was calculated. Radiographic damage was measured though modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). The association between mSASSS and SCORE was tested using generalized linear models (GLM), and an age-adjusted cluster analysis was performed to identify different phenotypes dependent on the subclinical CV risk.

Results: Increased traditional CV risk factors, SCORE, and the presence of carotid plaques were found in axSpA patients compared with HCs. The presence of atherosclerotic plaques and SCORE were associated with radiographic structural damage. The GLM showed that the total mSASSS was associated independently with the SCORE [β coefficient 0.24; 95% confidence interval (CI) 0.10-0.38] adjusted for disease duration, age, tobacco, C-reactive protein, and non-steroidal anti-inflammatory drugs (NSAID) intake. Hard cluster analysis identified two phenotypes of patients. Patients from cluster 1, characterized by the presence of plaques and increased cIMT, had a higher prevalence of CV risk factors and SCORE, and more structural damage than cluster two patients.

Conclusion: Radiographic structural damage is associated closely with increased estimated CV risk: higher SCORE levels in axSpA patients were found to be associated independently with mSASSS after adjusting for age, disease duration, CRP, tobacco and NSAID intake.

Keywords: axial spondyloarthritis; cardiovascular risk; carotid intima media thickness; disease activity; structural damage.