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. 2020 Dec 30:12:1759720X20982837.
doi: 10.1177/1759720X20982837. eCollection 2020.

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

María Lourdes Ladehesa-Pineda  1 , Iván Arias de la Rosa  2 , Clementina López Medina  2 , María Del Carmen Castro-Villegas  2 , María Del Carmen Ábalos-Aguilera  2 , Rafaela Ortega-Castro  2 , Ignacio Gómez-García  2 , Pedro Seguí-Azpilcueta  2 , Yolanda Jiménez-Gómez  2 , Alejandro Escudero-Contreras  2 , Chary López Pedrera  2 , Nuria Barbarroja  2 , Eduardo Collantes-Estévez  2 ; CASTRO Working Group
Affiliations

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

María Lourdes Ladehesa-Pineda et al. Ther Adv Musculoskelet Dis. .

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.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Association between SCORE levels and structural damage in axSpA patients. (A) Correlation between SCORE and total mSASSS. (B) Correlation between SCORE and cervical mSASSS. (C) Correlation between SCORE and lumbar mSASSS. (D) Correlation between SCORE and number of syndesmophytes. (E) Correlation between SCORE and number of bone bridges. **p <0.01, ***p <0.001, ****p <0.0001. axSpA, axial spondyloarthritis; mSASSS, modified Stoke ankylosing spondylitis spinal score.
Figure 2.
Figure 2.
Presence of atherosclerotic carotid plaques in axSpA patients according to structural damage. (A) Total mSASSS in axSpA patients with or without atherosclerotic plaques. (B) Cervical mSASSS in axSpA patients with or without atherosclerotic plaques. (C) Lumbar mSASSS in axSpA patients with or without atherosclerotic plaques. (D) Number of syndesmophytes in axSpA patients with or without atherosclerotic plaques. (E) Number of bone bridges in axSpA patients with or without atherosclerotic plaques. *p <0.05, ***p <0.001, ****p <0.0001 axSpA, axial spondyloarthritis; mSASSS, modified Stoke ankylosing spondylitis spinal score.
Figure 3.
Figure 3.
Cluster analysis recognizes two different phenotypes of axSpA patients according to their cardiovascular risk burden in terms of presence of carotid plaques and right and left cIMT levels. (A) Levels of right cIMT in cluster 1 and cluster 2. (B) Levels of left cIMT in cluster 1 and cluster 2. (C) Presence/absence of atherosclerotic plaques in cluster 1 and cluster 2. (D) Cluster analysis including presence of carotid plaques and right and left cIMT levels as variables distinguished two different phenotypes of patients with different cardiometabolic risk factors prevalence. ****p <0.0001. Apo A, apolipoprotein A; Apo B, apolipoprotein B; axSpA, axial spondyloarthritis; cIMT, carotid intima media thickness.
Figure 4.
Figure 4.
SCORE and structural damage in clusters recognizing two different phenotypes of axSpA patients according to the subclinical cardiovascular risk: atherosclerosis. (A) SCORE in cluster 1 and cluster 2. (B) Total mSASSS in cluster 1 and cluster 2. (C) Cervical mSASSS in cluster 1 and cluster 2. (D) Lumbar mSASSS in cluster 1 and cluster 2. (E) Number of bone bridges in cluster 1 and cluster 2. (F) Correlation between SCORE and right cIMT in cluster 1 and cluster 2. (G) Correlation between SCORE and total mSASSS in cluster 1 and cluster 2. ***p < 0.001, ****p < 0.0001. axSpA, axial spondyloarthritis; cIMT, carotid intima media thickness; mSASSS, modified Stoke ankylosing spondylitis spinal score.
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