Objectives To investigate lipid profile, inflammatory mediators, markers of endothelial activation and other clinical factors associated with cardiovascular risk in AS and PsA.
Methods Lipid profile, atherogenic index (AI –the TC: HDL)), CRP level, disease activity (BASDAI and ASDAS), patients BMI and risk factors like smoking and hypertension were evaluated in 21 AS patients (6 female, 15 male, mean age 41,6±7,4 years, with disease duration of 6,5 ±10,1 years) and in 18 PsA patients (8/f, 10/m, mean age 46,1± 10,6 y., disease duration 6.1±7,5 y.). Serum concentrations of ICAM-1, RANTES, CD40 Ligand were measured using ELISA. The SCORE calculator was used for CV risk estimation.
Results Mean values of BMI for AS and PsA patients, mean age and the disease duration did not differ significantly between the study groups. There were 9 smokers, 6 patients with hypertention and 3 patients with a coronary heart disease (CHD) in AS group and 5 smokers, 11 patients with hypertension, 3 with CHD in PsA. Mean values of BASDAI 5,9±1,9 SD in AS and 4,4±2,2 in PsA indicated active diseases. The SCORE CV risk above 5% was found in 4 patients (19%) with AS and in 3 PsA patients (16%). In AS AI (3.6±1) was significantly lower and HDL/LDL (0.51 ±0,1) higher vs. AI (4,4±1) and HDL/LDL (0,46± 0,1) in PsA (p<0,03).
14 (AS + PsA) smokers revealed higher serum levels of ICAM-1 (17,9± 7,7 ng/ml) comparing to 25 non –smokers (12,8±2,5 p=0.004). In AS we found significant (p<0,05) positive correlations between BASDAI values and HDL levels (r=0,4) and ASDAS and HDL (r=0,55) and negative correlations between BASDAI and AI (r= -0,60), ASDAS and AI (r= -0,50), BASDAI and CD 40 Ligand (r= -0,5). In PsA only BASDAI positively correlated with HDL levels (r=0,56). In non –smokers AI positively correlated with CD40 Ligand and CD40 Ligand negatively correlated with BASDAI. In smokers BASDAI and ASDAS positively correlated with HDL and BASDAI negatively with AI. We did not find any correlatinons between SCORE risk, disease activity, markers of inflammation and vascular injury.
Conclusions In our opinion the SCORE calculator underestimates CV risk in AS and PsA. Higher activity of the disease is associated with elevated HDL levels and decreased AI (a lipid paradox), which may suggest, that mostly in active AS, factors other then cholesterol-related are associated with the pathogenesis of CV disorders.
Neither lipid alterations nor inflammatory mediators but smoking seems to be the strongest factor associated with a direct vascular injury.
Disclosure of Interest None declared