Cardiovascular risk estimation in young patients with ankylosing spondylitis: A new model based on a prospective study in Constanta County, Romania

Ionescu,Mihaela; Ionescu,Paris; Suceveanu,Adrian Paul; Stoian,Anca Pantea; Motofei,Ion; Ardeleanu,Valeriu; Parepa,Irinel-Raluca

doi:10.3892/etm.2021.9961

Cardiovascular risk estimation in young patients with ankylosing spondylitis: A new model based on a prospective study in Constanta County, Romania

Authors:
- Mihaela Ionescu
- Paris Ionescu
- Adrian Paul Suceveanu
- Anca Pantea Stoian
- Ion Motofei
- Valeriu Ardeleanu
- Irinel-Raluca Parepa
View Affiliations

Affiliations: Department of Clinical Medical Sciences, Faculty of General Medicine, ‘Ovidius’ University of Constanta, 900527 Constanta, Romania, Department of Metabolic Diseases, Clinical Emergency Hospital, ‘Carol Davila’ University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania, Doctoral School, Faculty of Medicine, ‘Ovidius’ University of Constanta, 900527 Constanta, Romania
Published online on: March 22, 2021 https://doi.org/10.3892/etm.2021.9961
Article Number: 529

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Cardiovascular (CV) risk assessment charts are useful in establishing a patient therapeutic plan, but the most commonly used charts have essential limitations when applied to special populations. Our aim was to determine whether the Systematic Coronary Risk Evaluation (SCORE) chart underestimates the CV risk in young patients with ankylosing spondylitis (AS) and to promote the necessity of new risk assessment models. We conducted a prospective study in Constanta County, Romania including 70 consecutive patients ≤50 years of age, previously diagnosed with AS, without a history of established CV disease, diabetes mellitus and chronic kidney disease. We estimated the CV risk using SCORE based on total cholesterol, applied for a high‑risk population, such as the Romanian population. Estimation of CV risk was also conducted with the relative risk (RR) chart, considering the following variables: smoking, systolic blood pressure and total cholesterol. The majority of patients (n=46, 65.71%) had low risk according to the SCORE chart and only 24 (34.28%) were found to have moderate CV risk; none of them with high or very high CV risk. Ten patients (21.74%) of the 46 who were considered to have a low risk based on the SCORE system presented with carotid plaques. Twelve patients (50%) of the remaining 24 with moderate CV risk were found to have carotid plaques. According to 2016 ‘European Society of Cardiology’ (ESC) guidelines, 22 of all 70 patients were at high/very high CV risk due to the presence of carotid plaques. Comparing the RR chart with carotid plaque detection, only 4 out of 30 (13.3%) patients with RR=1 had carotid plaques; the frequency was higher in those with RR>1. Our results attested that the SCORE system underestimates the risk in patients with carotid plaques. Carotid ultrasound provided a more heightened sensitivity of the RR chart. C‑reactive protein (CRP) >3 mg/dl is associated with RR>1, making this chart a better CV risk predictive system in this particular category of patients.

View Figures

View References

1	Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, Qiu G, Cao X and Weng X: Ankylosing spondylitis: Etiology, pathogenesis, and treatments. Bone Res. 7(22)2019.PubMed/NCBI View Article : Google Scholar
2	Ranganathan V, Gracey E, Brown MA, Inman RD and Haroon N: Pathogenesis of ankylosing spondylitis-recent advances and future directions. Nat Rev Rheumatol. 13:359–367. 2017.PubMed/NCBI View Article : Google Scholar
3	Castañeda S, Martín-Martínez MA, González-Juanatey C, Llorca J, García-Yébenes MJ, Pérez-Vicente S, Sánchez-Costa JT, Díaz-Gonzalez F and González-Gay MA: CARMA Project Collaborative Group. Cardiovascular morbidity and associated risk factors in Spanish patients with chronic inflammatory rheumatic diseases attending rheumatology clinics: Baseline data of the CARMA Project. Semin Arthritis Rheum. 44:618–26. 2015.PubMed/NCBI View Article : Google Scholar
4	Authors/Task Force Members. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, et al: 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 252:207–274. 2016.PubMed/NCBI View Article : Google Scholar
5	Rocha E: Cardiovascular risk scores: Usefulness and limitations. Rev Port Cardiol. 35:15–8. 2016.PubMed/NCBI View Article : Google Scholar
6	Navarini L, Caso F, Costa L, Currado D, Stola L, Perrotta F, Delfino L, Sperti M, Deriu MA, Ruscitti P, et al: Cardiovascular risk prediction in ankylosing spondylitis: From traditional scores to machine learning assessment. Rheumatol Ther. 7:867–882. 2020.PubMed/NCBI View Article : Google Scholar
7	Paredes S, Rocha T, Mendes D, Carvalho P, Henriques J, Morais J, Ferreira J and Mendes M: New approaches for improving cardiovascular risk assessment. Rev Port Cardiol. 35:5–13. 2016.PubMed/NCBI View Article : Google Scholar
8	Soulaidopoulos S, Nikiphorou E, Dimitroulas T and Kitas GD: The role of statins in disease modification and cardiovascular risk in rheumatoid arthritis. Front Med (Lausanne). 5(24)2018.PubMed/NCBI View Article : Google Scholar
9	Rueda-Gotor J, Genre F, Corrales A, Blanco R, Fuentevilla P, Portilla V, Expósito R, Arnaiz CM, Pina T, González-Juanatey C, et al: Relative risk chart score for the assessment of the cardiovascular risk in young patients with ankylosing spondylitis. Int J Rheumatol. 2018(1847894)2018.PubMed/NCBI View Article : Google Scholar
10	Mathieu S and Soubrier M: Cardiovascular events in ankylosing spondylitis: A 2018 meta-analysis. Ann Rheum Dis. 78(e57)2019.PubMed/NCBI View Article : Google Scholar
11	Taurog JD, Chhabra A and Colbert RA: Ankylosing spondylitis and axial spondyloarthritis. N Engl J Med. 375(1303)2016.PubMed/NCBI View Article : Google Scholar
12	Yuan Y, Yang J, Zhang X, Han R, Chen M, Hu X, Ma Y, Wu M, Wang M, Xu S and Pan F: Carotid intima-media thickness in patients with ankylosing spondylitis: A systematic review and updated meta-analysis. J Atheroscler Thromb. 26:260–271. 2019.PubMed/NCBI View Article : Google Scholar
13	Bengtsson K, Klingberg E, Deminger A, Wallberg H, Jacobsson LTH, Bergfeldt L and Forsblad-d'Elia H: Cardiac conduction disturbances in patients with ankylosing spondylitis: Results from a 5-year follow-up cohort study. RMD Open. 5(e001053)2019.PubMed/NCBI View Article : Google Scholar
14	Palazzi C, Salvarani C, D'Angelo S and Olivieri I: Aortitis and periaortitis in ankylosing spondylitis. Joint Bone Spine. 78:451–455. 2011.PubMed/NCBI View Article : Google Scholar
15	Klingberg E, Sveälv BG, Täng MS, Bech-Hanssen O, Forsblad-d'Elia H and Bergfeldt L: Aortic regurgitation is common in ankylosing spondylitis: Time for routine echocardiography evaluation? Am J Med. 128:1244–1250.e1. 2015.PubMed/NCBI View Article : Google Scholar
16	Midtbø H, Semb AG, Matre K, Rollefstad S, Berg IJ and Gerdts E: Left ventricular systolic myocardial function in ankylosing spondylitis. Arthritis Care Res (Hoboken). 71:1276–1283. 2019.PubMed/NCBI View Article : Google Scholar
17	Cozlea DL, Farcas DM, Nagy A, Keresztesi AA, Tifrea R, Cozlea L and Carașca E: The impact of C reactive protein on global cardiovascular risk on patients with coronary artery disease. Curr Health Sci J. 39:225–31. 2013.PubMed/NCBI
18	Van der Linden S, Valkenburg HA and Cats A: Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 27:361–368. 1984.PubMed/NCBI View Article : Google Scholar
19	Libby P: Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 32:2045–2051. 2012.PubMed/NCBI View Article : Google Scholar
20	Steven S, Frenis K, Oelze M, Kalinovic S, Kuntic M, Bayo Jimenez MT, Vujacic-Mirski K, Helmstädter J, Kröller-Schön S, Münzel T and Daiber A: Vascular inflammation and oxidative stress: Major triggers for cardiovascular disease. Oxid Med Cell Longev. 2019(7092151)2019.PubMed/NCBI View Article : Google Scholar
21	Crowson CS, Liao KP, Davis JM III, Solomon DH, Matteson EL, Knutson KL, Hlatky MA and Gabriel SE: Rheumatoid arthritis and cardiovascular disease. Am Heart J. 166:622–628.e1. 2013.PubMed/NCBI View Article : Google Scholar
22	Marchio P, Guerra-Ojeda S, Vila JM, Aldasoro M, Victor VM and Mauricio MD: Targeting early atherosclerosis: A focus on oxidative stress and inflammation. Oxid Med Cell Longev. 2019(8563845)2019.PubMed/NCBI View Article : Google Scholar
23	Montecucco F and Mach F: Common inflammatory mediators orchestrate pathophysiological processes in rheumatoid arthritis and atherosclerosis. Rheumatology (Oxford). 48:11–22. 2009.PubMed/NCBI View Article : Google Scholar
24	Han C, Robinson DWJ, Hackett MV, Paramore LC, Fraeman KH and Bala MV: Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 33:2167–72. 2006.PubMed/NCBI
25	El Maghraoui A: Extra-articular manifestations of ankylosing spondylitis: Prevalence, characteristics and therapeutic implications. Eur J Intern Med. 22:554–560. 2011.PubMed/NCBI View Article : Google Scholar
26	de Winter JJ, van Mens LJ, van der Heijde D, Landewé R and Baeten DL: Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: A meta-analysis. Arthritis Res Ther. 18(196)2016.PubMed/NCBI View Article : Google Scholar
27	Ozkan Y: Cardiac involvement in ankylosing spondylitis. J Clin Med Res. 8:427–430. 2016.PubMed/NCBI View Article : Google Scholar
28	Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD and Macfarlane GJ: Global prevalence of ankylosing spondylitis. Rheumatology (Oxford). 53:650–657. 2014.PubMed/NCBI View Article : Google Scholar
29	Boonen A: Socioeconomic consequences of ankylosing spondylitis. Clin Exp Rheumatol. 20 (Suppl 28):S23–S26. 2002.PubMed/NCBI
30	Frostegård J: Immunity, atherosclerosis and cardiovascular disease. BMC Med. 11(117)2013.PubMed/NCBI View Article : Google Scholar
31	Legge A and Hanly JG: Managing premature atherosclerosis in patients with chronic inflammatory diseases. CMAJ. 190:E430–E439. 2018.PubMed/NCBI View Article : Google Scholar
32	Lostun A, Lostun G and Hainarosie R: A retrospective study of non-violent deaths and diagnosis discrepancies over a period of three years. Rev Chim. 67:1587–1590. 2016.
33	Niiranen TJ and Vasan RS: Epidemiology of cardiovascular disease: Recent novel outlooks on risk factors and clinical approaches. Expert Rev Cardiovasc Ther. 14:855–869. 2016.PubMed/NCBI View Article : Google Scholar
34	Tournadre A, Mathieu S and Soubrier M: Managing cardiovascular risk in patients with inflammatory arthritis: Practical considerations. Ther Adv Musculoskelet Dis. 8:180–191. 2016.PubMed/NCBI View Article : Google Scholar
35	Shen J, Shang Q and Tam LS: Targeting inflammation in the prevention of cardiovascular disease in patients with inflammatory arthritis. Transl Res. 167:138–151. 2016.PubMed/NCBI View Article : Google Scholar
36	Landi M, Maldonado-Ficco H, Perez-Alamino R, Maldonado-Cocco JA, Citera G, Arturi P, Sampaio-Barros PD, Flores Alvarado DE, Burgos-Vargas R, Santos E, et al: Gender differences among patients with primary ankylosing spondylitis and spondylitis associated with psoriasis and inflammatory bowel disease in an iberoamerican spondyloarthritis cohort. Medicine (Baltimore). 95(e5652)2016.PubMed/NCBI View Article : Google Scholar
37	Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, Kvien TK, Dougados M, Radner H, Atzeni F, et al: EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 76:17–28. 2016.PubMed/NCBI View Article : Google Scholar
38	Nitipir C, Orlov-Slavu C, Olaru M, Parosanu A, Popa AM, Iaciu C, Popescu BC, Barbu MA, Pirlog C, Calu V, et al: The Importance of dose intensity when administering cytotoxic chemotherapy in NSCLC-A matter as actual now as in the past. Processes. 8(936)2020.
39	Serban D, Smarandache AM, Cristian D, Tudor C, Duta L and Dascalu AM: Medical errors and patient safety culture-shifting the healthcare paradigm in Romanian hospitals. Rom J Leg Med. 28:195–201. 2020.