Background Rheumatoid arthritis is associated with increased cardiovascular risk. In the guidelines, ankylosing spondylitis (AS) is considered to have an equally high cardiovascular risk. The literature findings remain controversial.
Objectives To assess the risk of myocardial infarction (MI) and stroke in AS patients in 2013.
Methods An updated meta-analysis with a new systematic literature review using PubMed was conducted up to December 2013. Incidence of MI or stroke was calculated by metaproportion.
Results In addition to the eleven previously included studies, five new studies assessed the occurrence of MI or stroke in AS patients.
1. MI: 726 MI were reported in AS patients (N=18,916) over mean follow-up of sixteen years: incidence 5.5% [3.9%, 7.4%], i.e. 0.44/100 pyrs. Seven studies revealed 17,410 MI (2.5% (95% CI [1.8%, 3.4%])) in the control group (N=1,349,964). Meta-analysis of the seven longitudinal studies showed a significant increase in MI (RR=1.46 [1.33, 1.60]) in AS patients. 2. Stroke: In ten longitudinal studies (N=43,374), 1,370 strokes were reported in AS patients over 18.5 years of follow-up: incidence 3.4% [1.2%, 6.8%], i.e. 0.1/100 pyrs. Three studies reported 22,899 strokes in controls (N=1,239,041), giving an incidence of 1.78% [1.75%, 1.80%]. A significant increase in stroke (RR=1.50 [1.39, 1.62]) in AS patients was found.
Conclusions AS patients appear to have a higher risk of MI and stroke. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS.
Disclosure of Interest None declared