Background We performed a descriptive study of our patients with spondyloarthropathies (SpA) in biologic therapy attending to the presence of coronary disease and cardiovascular risk factors.
Methods Patients with spondyloarthropathies and anti-TNF treatment attending clinics at the Department of Rheumatology were analyzed to determine how many of them presented coronary disease during biologic therapy. The following information was recorded: age, sex, type of SpA, disease duration and age at the coronary event, HLA-B27 positivity, hypertension, type II diabetes and hyperlipidemia, on medical records and discharge reports for each patient.
Results All 127 patients were identified from an electronic database. There was a marked male predominance:70.1% versus 29.9% of women. We found a mean age of 47.2±12.8 years. Of the 127 patients 41.7% had a peripheral spondyloarthritis, 40.9% had an axial spondyloarthritis and 17.3% had a mixed type of disease. With regard to HLA-B27, 49.6% patients had a positive test, 29.1% were HLA-B27 negative and 21.3% showed lack of HLA-B27 test. Almost all patients were in DMARDs therapy, 96.1%, while 100% were treated with TNF blockers: etanercept 52%, infliximab 31.5%, adalimumab 13.4%, golimumab 2.4% and certolizumab 0.8%. Attending to cardiovascular risk factors, we found a prevalence of 42.5% of hyperlipidemia, 33.1% of hypertension, and 7.9% of type II diabetes. Patients received treatment for their hypertension, hyperlipidemia and type II diabetes in all cases. We recorded 2 cases of cardiovascular events prior to biologic treatment: a case of coronary heart disease that required revascularization and a case of atrial fibrillation. After starting anti-TNF treatment we recorded 4 cases of cardiovascular events: 2 cases of acute coronary syndrome with subsequent revascularization, a case of cardiac syncope and a case of thoracic aortic aneurysm. Three of these 4 patients were treated with etanercept, and the remaining patient was treated with infliximab.
Conclusions Over the past two decades it has become increasingly clear that chronic inflammation is an independent risk factor for cardiovascular events. Recent studies shows that cardiovascular diseases and their risk factors are more common in patients with spondyloarthritis than in matched controls. In our study the ratio of ischemic heart disease for patients with spondyloarthropathies after starting biologic treatment is 3.1, which is higher than previously described for the overall group of spondyloarthritis (1.5-2). This may be due to the limited number of patients in our study, and the fact that patients in biologic treatment represent a selected population with more severe disease and increased inflammatory activity. Proper management of cardiovascular risk requires aggressive control of disease activity. Guidelines for optimal cardiovascular risk reduction in patients with spondyloarthritis are lacking.
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Disclosure of Interest None Declared