CARDIOVASCULAR RISK IN PATIENTS WITH ANKYLOSING SPONDYLITIS: THE ROLE OF SYSTEMIC INFLAMMATION AND ENDOTHELIAL DYSFUNCTION

Abstract

Aim. To investigate the role of systemic inflammation and endothelial dysfunction as factors of cardiovascular risk in patients with ankylosing spondylitis.Material andMethods. 100 patients with ankylosing spondylitis were included into the study. Screening for arterial hypertension (HT) and conventional cardiovascular risk factors (smoking, hyper- and dislipoproteinemia, body overweight, heredity and diabetes mellitus) was performed in all patients. 10-year coronary disease risk (Framingham scale) and 10-year risk of fatal cardiovascular event (SCORE scale) was calculated. Additionally the follows cardiovascular risk factors were assessed: C-reactive protein level (CRP), fibrinogen level, platelet count, antithrombin III activity, plasma fibrinolytic activity, vonWillebrand factor (vWF) activity, circulating endothelial cells (CEC) count. Besides, endothelial functionwas evaluated by Doppler-ultrasonography of brachial artery in testswith reactive (endothelium-dependent or flow-mediated dilation) and nitroglycerine (endotheliumindependent dilation) hyperemia. 30 healthy patients were included into control group and were comparable with patients of studied group on sex and age.Results. 10-year coronary disease risk in patients with ankylosing spondylitis was significantly lower than this in patients of control group 4.0%(3,0; 7,5) vs 5.0%(3,0; 11,0), respectively (p<0,05). 10-year risk of fatal cardiovascular event in studied group was relatively low 1.0% (1.0; 2.0). However, analysis of the additional risk factors shown increased thrombogenic potential of blood, which was related to systemic inflammation activity: high platelets count, high fibrinogen activity, increased vWF activity, and decreased fibrinolytic activity. Moreover, signs of endothelial injury (increased level of CEC and vWF activity) and endothelial dysfunction were found in patients with ankylosing spondylitis.Conclusion. Cardiovascular risk in patientswith ankylosing spondylitis estimated on the basis of conventional risk factors is not higher than this in general population. At the same time, these patients have signs of endothelial injure, dysfunction, and increased thrombogenic potential directly related to the systemic inflammation activity.We suppose these factors are responsible for the increased cardiovascular risk in patients with ankylosing spondylitis and, therefore, should be taken into account upon cardiovascular risk assessment.

Keywords

• ankylosing spondylitis
• cardiovascular risk
• systemic inflammation
• endothelial dysfunction