Increase in Cardiovascular Risk Factors Related to Higher Disease Activity in Patients With Axial Spondyloarthritis

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Researchers assessed the association between traditional cardiovascular risk factors and disease activity in patients with axial spondyloarthritis.

Among patients with axial spondyloarthritis (axSpA), an increase in traditional cardiovascular (CV) risk factors is correlated with an increase in disease activity, according to study results published in Therapeutic Advances in Musculoskeletal Disease.

Occurrence of CV risk factors have been linked to pathways that share common mediators and mechanisms related to inflammation and inflammatory disorders, such as axSpA. Several studies have suggested an increase in hypertension, type 2 diabetes, obesity, and dyslipidemia in patients with axSpA compared with healthy individuals.

In a cross-sectional study, researchers assessed whether patients with a higher number of CV risk factors had higher axSpA disease activity or if the number of CV risk factors was related to other disease characteristics.

Patients with axSpA underwent a physical examination and completed a survey, which the researchers used to determine CV risk factors and medication use. Five CV risk factors were defined at study onset: dyslipidemia, hypertension, obesity, smoking status, and diabetes.

A total of 804 patients with axSpA were included in the analysis, with 31% not showing any CV risk factors and 69% having a least 1 CV risk factor. Overall, 35% (n=285), 21% (n=168), and 13% (n=101) of patients had 1, 2, and 3 or more CV risk factors, respectively.

The Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP) activity score was significantly higher in patients with 1 (β, 0.3; P =.001) and 2 or more (β, 0.5; P =.000] CV risk factors compared with those without CV risk factors. Patients with 1 and 2 or more CV risk factors vs those with no CV risk factors had a higher odds ratio (OR) for the presence of high and very high disease activity (ORs, 2.00 [P =.053] and 3.39 [P =.000], respectively).

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) total score was 3.7 (interquartile range, 1.8-5.5). A total of 44% of patients had a BASDAI score of 4 or greater, which the researchers noted was significantly associated with the number of CV risk factors, being higher in patients with 2 or more CV risk factors compared with those with no CV risk factors (P =.003).  Similar outcomes were seen when CV risk factors were assessed against the Bath Ankylosing Spondylitis Functional Index (BASFI) score and the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). 

The study is limited by the ability to determine causality, the lack of recording the duration or severity of CV risk factors and if these factors were present before or after diagnosis of axSpA, Prior medication use was not examined, and other comorbidities, such as depression, impaired physical activity, family history of CV disease, and lifestyle habits, were not included. The researchers recommended that future longitudinal studies were needed to address these study limitations.

“Our findings support the argument that control of CV risk factors may have beneficial effects not only on CV disease and/or CV events, but also on disease control, since they correlate with higher disease activity,” the researchers concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Ferraz-Amaro I, Rudea-Gotor J, Genre F, et al. Potential relation of cardiovascular risk factors to disease activity in patients with axial spondyloarthritis. Ther Adv Musculoskelet Dis. Published online July 28, 2021. doi:10.1177/1759720X211033755