Objectives Accelerated atherosclerosis and increased cardiovascular morbidity and mortality have been associated with ankylosing spondylitis (AS). Noninvasive angiological methods have been developped to evaluate endothelial and vascular dysfunction which is correlated with future development of atherosclerosis. The objectives were to determinate the presence or not of a subclinical vascular dysfunction in AS and if treatments could have an effect on it. A systematic review was done.
Methods Studies evaluating subclinical atherosclerosis and vascular function in AS were identified using Pubmed, (Ovid, EMBASE). Search terms included “ankylosing spondylitis” AND (endothelial OR vascular OR intima media thickness (IMT) OR Flow mediated dilatation (FMD) OR pulse wave velocity (PWV) OR atherosclerosis). This identified 353 results after limiting to French and English. The final selection identified 29 articles.
Results Overall, 1529 AS patients were included representing 38 studies: 8 studies about endothelial function, 198 AS patients and 130 healthy control (HC); 20 studies about carotid IMT, 900 AS and 644 HC; 10 studies about arterial rigidity, 431 AS and 285 HC. In cross-sectional studies, 4/6 indicated endothelial dysfunction in AS versus HC, 9/18 indicated increased cIMT and 3/5 increased arterial rigidity. About ED, 3 open label studies noted positive effect of TNFα blockers and spironolactone on FMD and rosuvastatin improved FMD in a placebo controlled study after 24 weeks. TNFα blockers seems not to improve neither cIMT (2 studies) nor arterial rigidity (5 studies). Exercise alone has improved arterial rigidity in 15 patients after 12 weeks.
Conclusions Whereas early and accelerated atherosclerosis is patent in AS, presence of subclinical atherosclerotic lesions is controversial in the literature especially concerning cIMT and arterial stiffness. This is reinforced by the lack of TNF blockers efficacy. Conversely it seems that endothelial dysfunction is present and reversible after treatment with TNF blockers, statin and spironolactone. These results are consistent to treat AS patients with early effective treatment to prevent the risk of CV morbidity and mortality.
Disclosure of Interest None declared