In patients with spondyloarthritis (SpA) without overt cardiovascular disease (CVD), decreases in renal function and radiographic evidence of syndesmophytes are both associated with the development of subclinical accelerated atherosclerosis. Traditional CVD risk factors do not appear to accurately identify those patients in whom CVD will progress rapidly.

The prospective observational study, reported in Clinical Rheumatology, sought to assess the prevalence and clinical predictors of accelerated subclinical atherosclerosis in patients with SpA with the use of carotid ultrasonography. Ultrasound evaluation of carotid intima-media thickness (cIMT) and plaques helps assess the actual CVD risk in such individuals, particularly patients who are at intermediate risk.

A total of 66 patients with SpA who were free of CVD based on the Assessment of SpondyloArthritis International Society criteria, were included in the analysis. All participants were evaluated at baseline and then after 13.5±3.6 months. Clinical variables evaluated in this study included hypertension, obesity, dyslipidemia, renal function, and SpA disease activity. The extent of a patient’s subclinical atherosclerosis was examined via ultrasound measurements of cIMT and distensibility coefficient (cDC). The rate of cIMT progression was calculated by dividing the cIMT change by the time between ultrasound scans.


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In this investigation, accelerated atherosclerosis was defined as the highest cIMT progression rate quartile. At follow-up, cIMT increased slightly in 59% (39 of 66) of
patients (mean difference, 0.01± 0.10; P =.334). The mean cIMT progression rate was
0.01 mm/year (95% CI, -0.02 to 0.03). Overall, accelerated atherosclerosis was observed in 24% (16 of 66) of patients. Mean cDC was unchanged at follow-up.

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At baseline, patients’ mean Framingham Risk Score for CVD at 10 years was high—
13.6%±10.5%; in fact, 57.6% of participants had a score ≥10% (intermediate-/high-risk). In the participants with accelerated atherosclerosis (n=16), significantly higher serum creatinine and lower glomerular filtration rates were reported at baseline.

In patients with SpA and no overt CVD, impaired renal function and radiographic damage are both associated with the development of accelerated subclinical atherosclerosis. According to the investigators, longitudinal assessment of cIMT might help to better evaluate the CVD risk in such individuals, thus improving their prognostic stratification.

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Reference

Giollo A, Dalbeni A, Cioffi G, et al. Factors associated with accelerated subclinical atherosclerosis in patients with spondyloarthritis without overt cardiovascular disease [published online September 9, 2017]. Clin Rheumatol. doi:10.1007/s10067-017-3786-3