Ankylosing spondylitis and risk of ischaemic heart disease: a population-based cohort study

Ivette Essers; Carmen Stolwijk; Annelies Boonen; Marie L De Bruin; Marloes T Bazelier; Frank de Vries; Astrid van Tubergen

doi:10.1136/annrheumdis-2014-206147

Ankylosing spondylitis and risk of ischaemic heart disease: a population-based cohort study

Ivette Essers, Carmen Stolwijk, Annelies Boonen, Marie L De Bruin, Marloes T Bazelier, Frank de Vries, Astrid van Tubergen

46 Citations (Scopus)

Abstract

OBJECTIVE: To investigate the incidence and risk of ischaemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of non-steroidal anti-inflammatory drugs (NSAID), in patients with ankylosing spondylitis (AS) compared with population controls.

METHODS: All patients with newly diagnosed AS (n=3809) from the British Clinical Practice Research Datalink (1987-2012) were matched with up to seven persons without AS by year of birth, gender and practice (n=26 197). Incidence rate ratios (IRR) and HRs for development of IHD and AMI were calculated. Stepwise analyses were performed adjusting for age, gender, comorbidity and drug use, including NSAIDs.

RESULTS: At baseline, 4.3% of the patients had IHD and 1.8% had AMI compared with 3.4% and 1.4% of the controls, respectively. After exclusion of pre-existing IHD or AMI, the IRRs were 1.18 (95% CI 0.96 to 1.46) and 0.91 (95% CI 0.65 to 1.27) for IHD and AMI, respectively. Compared with controls, the age-gender adjusted HR for developing IHD was 1.20 (95% CI 0.97 to 1.48), and for AMI 0.91 (95% CI 0.65 to 1.28). In female patients, the risk of developing IHD was increased (HR 1.88, 95% CI 1.22 to 2.90), but after adjustment for all possible risk factors only a non-significant trend was found (HR 1.31, 95% CI 0.83 to 2.08). In particular, NSAID use explained this change (HR IHD adjusted for age-gender-NSAID use 1.57, 95% CI 0.99 to 2.48).

CONCLUSIONS: Female patients with AS had an increased age-adjusted risk of developing IHD, but after adjustment for NSAID use only a non-significant trend towards increased risk was found.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	75
Issue number	1
Pages (from-to)	203-9
Number of pages	7
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2014-206147
Publication status	Published - 1 Jan 2016
Externally published	Yes

Keywords

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal
Cohort Studies
Databases, Factual
Drug Utilization
Female
Great Britain
Humans
Incidence
Male
Middle Aged
Myocardial Infarction
Myocardial Ischemia
Prevalence
Risk Assessment
Risk Factors
Sex Factors
Spondylitis, Ankylosing
Young Adult
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

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10.1136/annrheumdis-2014-206147

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@article{35bd25756506444e872645a2dc500cb8,

title = "Ankylosing spondylitis and risk of ischaemic heart disease: a population-based cohort study",

abstract = "OBJECTIVE: To investigate the incidence and risk of ischaemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of non-steroidal anti-inflammatory drugs (NSAID), in patients with ankylosing spondylitis (AS) compared with population controls.METHODS: All patients with newly diagnosed AS (n=3809) from the British Clinical Practice Research Datalink (1987-2012) were matched with up to seven persons without AS by year of birth, gender and practice (n=26 197). Incidence rate ratios (IRR) and HRs for development of IHD and AMI were calculated. Stepwise analyses were performed adjusting for age, gender, comorbidity and drug use, including NSAIDs.RESULTS: At baseline, 4.3% of the patients had IHD and 1.8% had AMI compared with 3.4% and 1.4% of the controls, respectively. After exclusion of pre-existing IHD or AMI, the IRRs were 1.18 (95% CI 0.96 to 1.46) and 0.91 (95% CI 0.65 to 1.27) for IHD and AMI, respectively. Compared with controls, the age-gender adjusted HR for developing IHD was 1.20 (95% CI 0.97 to 1.48), and for AMI 0.91 (95% CI 0.65 to 1.28). In female patients, the risk of developing IHD was increased (HR 1.88, 95% CI 1.22 to 2.90), but after adjustment for all possible risk factors only a non-significant trend was found (HR 1.31, 95% CI 0.83 to 2.08). In particular, NSAID use explained this change (HR IHD adjusted for age-gender-NSAID use 1.57, 95% CI 0.99 to 2.48).CONCLUSIONS: Female patients with AS had an increased age-adjusted risk of developing IHD, but after adjustment for NSAID use only a non-significant trend towards increased risk was found.",

keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Cohort Studies, Databases, Factual, Drug Utilization, Female, Great Britain, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Myocardial Ischemia, Prevalence, Risk Assessment, Risk Factors, Sex Factors, Spondylitis, Ankylosing, Young Adult, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't",

author = "Ivette Essers and Carmen Stolwijk and Annelies Boonen and {De Bruin}, {Marie L} and Bazelier, {Marloes T} and {de Vries}, Frank and {van Tubergen}, Astrid",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/",

year = "2016",

month = jan,

day = "1",

doi = "10.1136/annrheumdis-2014-206147",

language = "English",

volume = "75",

pages = "203--9",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "B M J Group",

number = "1",

}

TY - JOUR

T1 - Ankylosing spondylitis and risk of ischaemic heart disease

T2 - a population-based cohort study

AU - Essers, Ivette

AU - Stolwijk, Carmen

AU - Boonen, Annelies

AU - De Bruin, Marie L

AU - Bazelier, Marloes T

AU - de Vries, Frank

AU - van Tubergen, Astrid

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016/1/1

Y1 - 2016/1/1

N2 - OBJECTIVE: To investigate the incidence and risk of ischaemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of non-steroidal anti-inflammatory drugs (NSAID), in patients with ankylosing spondylitis (AS) compared with population controls.METHODS: All patients with newly diagnosed AS (n=3809) from the British Clinical Practice Research Datalink (1987-2012) were matched with up to seven persons without AS by year of birth, gender and practice (n=26 197). Incidence rate ratios (IRR) and HRs for development of IHD and AMI were calculated. Stepwise analyses were performed adjusting for age, gender, comorbidity and drug use, including NSAIDs.RESULTS: At baseline, 4.3% of the patients had IHD and 1.8% had AMI compared with 3.4% and 1.4% of the controls, respectively. After exclusion of pre-existing IHD or AMI, the IRRs were 1.18 (95% CI 0.96 to 1.46) and 0.91 (95% CI 0.65 to 1.27) for IHD and AMI, respectively. Compared with controls, the age-gender adjusted HR for developing IHD was 1.20 (95% CI 0.97 to 1.48), and for AMI 0.91 (95% CI 0.65 to 1.28). In female patients, the risk of developing IHD was increased (HR 1.88, 95% CI 1.22 to 2.90), but after adjustment for all possible risk factors only a non-significant trend was found (HR 1.31, 95% CI 0.83 to 2.08). In particular, NSAID use explained this change (HR IHD adjusted for age-gender-NSAID use 1.57, 95% CI 0.99 to 2.48).CONCLUSIONS: Female patients with AS had an increased age-adjusted risk of developing IHD, but after adjustment for NSAID use only a non-significant trend towards increased risk was found.

AB - OBJECTIVE: To investigate the incidence and risk of ischaemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of non-steroidal anti-inflammatory drugs (NSAID), in patients with ankylosing spondylitis (AS) compared with population controls.METHODS: All patients with newly diagnosed AS (n=3809) from the British Clinical Practice Research Datalink (1987-2012) were matched with up to seven persons without AS by year of birth, gender and practice (n=26 197). Incidence rate ratios (IRR) and HRs for development of IHD and AMI were calculated. Stepwise analyses were performed adjusting for age, gender, comorbidity and drug use, including NSAIDs.RESULTS: At baseline, 4.3% of the patients had IHD and 1.8% had AMI compared with 3.4% and 1.4% of the controls, respectively. After exclusion of pre-existing IHD or AMI, the IRRs were 1.18 (95% CI 0.96 to 1.46) and 0.91 (95% CI 0.65 to 1.27) for IHD and AMI, respectively. Compared with controls, the age-gender adjusted HR for developing IHD was 1.20 (95% CI 0.97 to 1.48), and for AMI 0.91 (95% CI 0.65 to 1.28). In female patients, the risk of developing IHD was increased (HR 1.88, 95% CI 1.22 to 2.90), but after adjustment for all possible risk factors only a non-significant trend was found (HR 1.31, 95% CI 0.83 to 2.08). In particular, NSAID use explained this change (HR IHD adjusted for age-gender-NSAID use 1.57, 95% CI 0.99 to 2.48).CONCLUSIONS: Female patients with AS had an increased age-adjusted risk of developing IHD, but after adjustment for NSAID use only a non-significant trend towards increased risk was found.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anti-Inflammatory Agents, Non-Steroidal

KW - Cohort Studies

KW - Databases, Factual

KW - Drug Utilization

KW - Female

KW - Great Britain

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Myocardial Ischemia

KW - Prevalence

KW - Risk Assessment

KW - Risk Factors

KW - Sex Factors

KW - Spondylitis, Ankylosing

KW - Young Adult

KW - Journal Article

KW - Multicenter Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1136/annrheumdis-2014-206147

DO - 10.1136/annrheumdis-2014-206147

M3 - Journal article

C2 - 25362044

SN - 0003-4967

VL - 75

SP - 203

EP - 209

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 1

ER -

Ankylosing spondylitis and risk of ischaemic heart disease: a population-based cohort study

Abstract

Keywords

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