Lin-Hong Shi, Steven H Lam, Ho So, Edmund K Li, Tena K Li, Cheuk-Chun Szeto, Lai-Shan Tam
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The performance of the original and modified (*1.5 multiplication factor) CV risk algorithms were assessed. Time-varying Cox proportional hazard models and Kaplan-Meier survival analysis were used to assess whether inflammatory burden (Bath ankylosing spondylitis disease activity index [BASDAI] and inflammatory markers), nonsteroidal anti-inflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs) can predict the development of first CVE.</p><p><strong>Results: </strong>463 patients (35 [26-45] years, male: 360 [77.8%]) were recruited. After a median follow-up of 12 (7-19) years, 61 patients (13.2%) experienced a first CVE. Traditional/modified CV risk scores underestimated CV risk. Erythrocyte sedimentation rate (ESR) ⩾ 20 mm/h was associated with a significantly higher risk of CVE during follow-up (HR: 2.07, 95%CI [1.10, 3.98], <i>p</i> = 0.008). Active disease as indicated by a rising BASDAI also showed positive trend towards a higher risk of developing CVE over time. After adjusting for CV risk scores in the multivariable models, high ESR level (ESR ⩾ 20 mm/h) over time remained significantly associated with a higher risk of developing CV events.</p><p><strong>Conclusion: </strong>Increased inflammatory burden as reflected by elevated ESR levels (ESR ⩾ 20) was associated with increased risk of CVE, while the use of NSAIDs and DMARDs were not.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2c/8b/10.1177_1759720X221122401.PMC9465578.pdf","citationCount":"1","resultStr":"{\"title\":\"High inflammatory burden predicts cardiovascular events in patients with axial spondyloarthritis: a long-term follow-up study.\",\"authors\":\"Lin-Hong Shi, Steven H Lam, Ho So, Edmund K Li, Tena K Li, Cheuk-Chun Szeto, Lai-Shan Tam\",\"doi\":\"10.1177/1759720X221122401\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Axial spondyloarthritis (axSpA) patients are at higher risk of cardiovascular (CV) disease (CVD) than the general population, partly due to consequences of inflammation or its treatment. 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引用次数: 1
摘要
背景:轴性脊柱炎(axSpA)患者发生心血管(CV)疾病(CVD)的风险高于一般人群，部分原因是炎症或其治疗的后果。但axSpA炎症与心血管事件(CVE)之间的关系尚不清楚。目的:研究炎症负担随时间的变化是否可以独立于基线CV危险因素预测axSpA患者的CVE。设计:对2001年1月以来招募的患者进行队列分析。主要结果是2001年1月至2020年12月期间发生的第一次CVE。方法:在基线时计算三个心血管疾病风险评分。评估了原始和改进的(*1.5倍因子)CV风险算法的性能。采用时变Cox比例风险模型和Kaplan-Meier生存分析来评估炎症负担(巴斯强直性脊柱炎疾病活动性指数[BASDAI]和炎症标志物)、非甾体抗炎药(NSAIDs)和疾病改善抗风湿药(DMARDs)是否可以预测首次CVE的发展。结果:共纳入463例患者，年龄35[26-45]岁，男性360例(77.8%)。中位随访12年(7-19年)后，61例患者(13.2%)经历了首次CVE。传统/改良的心血管风险评分低估了心血管风险。红细胞沉降率(ESR)大于或等于20 mm/h与随访期间CVE的风险显著增加相关(HR: 2.07, 95%CI [1.10, 3.98]， p = 0.008)。随着时间的推移，BASDAI升高所表明的活动性疾病也显示出发生CVE风险增加的积极趋势。在调整多变量模型中的CV风险评分后，随着时间的推移，高ESR水平(ESR大于或等于20 mm/h)仍然与发生CV事件的高风险显著相关。结论:ESR水平升高(ESR大于或等于20)所反映的炎症负担增加与CVE风险增加相关，而非甾体抗炎药和dmard的使用则无关。
High inflammatory burden predicts cardiovascular events in patients with axial spondyloarthritis: a long-term follow-up study.
Background: Axial spondyloarthritis (axSpA) patients are at higher risk of cardiovascular (CV) disease (CVD) than the general population, partly due to consequences of inflammation or its treatment. But relationship between inflammation in axSpA and cardiovascular events (CVE) is unknown.
Objectives: To examine whether inflammatory burden over time can predict CVE independent of baseline CV risk factors in axSpA patients.
Design: A cohort analysis was performed in patients who had been recruited since January 2001. The primary outcome was a first CVE occurring between January 2001 and December 2020.
Methods: Three CVD risk scores were computed at baseline. The performance of the original and modified (*1.5 multiplication factor) CV risk algorithms were assessed. Time-varying Cox proportional hazard models and Kaplan-Meier survival analysis were used to assess whether inflammatory burden (Bath ankylosing spondylitis disease activity index [BASDAI] and inflammatory markers), nonsteroidal anti-inflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs) can predict the development of first CVE.
Results: 463 patients (35 [26-45] years, male: 360 [77.8%]) were recruited. After a median follow-up of 12 (7-19) years, 61 patients (13.2%) experienced a first CVE. Traditional/modified CV risk scores underestimated CV risk. Erythrocyte sedimentation rate (ESR) ⩾ 20 mm/h was associated with a significantly higher risk of CVE during follow-up (HR: 2.07, 95%CI [1.10, 3.98], p = 0.008). Active disease as indicated by a rising BASDAI also showed positive trend towards a higher risk of developing CVE over time. After adjusting for CV risk scores in the multivariable models, high ESR level (ESR ⩾ 20 mm/h) over time remained significantly associated with a higher risk of developing CV events.
Conclusion: Increased inflammatory burden as reflected by elevated ESR levels (ESR ⩾ 20) was associated with increased risk of CVE, while the use of NSAIDs and DMARDs were not.
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