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Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis?
  1. Jonas K Eriksson1,
  2. Lennart Jacobsson2,
  3. Karin Bengtsson2,
  4. Johan Askling1,3
  1. 1Clinical Epidemiology Unit and Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  3. 3Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Professor Johan Askling, Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm SE-17176, Sweden; johan.askling{at}


Aims To assess and compare the incidence of cardiovascular (CV) events, by CV phenotype, between patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA) and the general population.

Methods Using linkages of national and population-based registers, we identified one cohort of prevalent patients with AS (n=5358), one with RA (n=37 245) and one with matched general population subjects (n=25 006). These cohorts were identified in 2006 through 2011 and were followed in 31 December 2012, for first ever occurrence of acute coronary syndromes (ACS), deep venous thromboembolism, pulmonary embolism and stroke, respectively. For each outcome, we calculated incidence rates standardised to the age and sex distribution of the AS cohort, as well as relative risks using Cox proportional hazards models.

Results Based on 69 ACS events during 20 251 person-years of follow-up of the patients with AS, and 966 events during 127 014 person-years in the RA cohort, the age/sex-adjusted relative risks for ACS compared with the general population was 1.3 (95% CI 1.0 to 1.7) for AS and 1.7 (1.4 to 2.0) for RA. For thromboembolic events, the corresponding risks were 1.4 (1.1 to 1.9) in AS and 1.8 (1.5 to 2.1) in RA. Finally, for stroke, the relative risks were 1.5 (1.1 to 2.0) in AS and 1.5 (1.2 to 1.8) in RA, compared with the general population.

Conclusions Prevalent patients with AS are at a 30%–50% increased risk of incident CV events. When compared with patients with RA, this level of increase was similar for stroke, but only half as high for ACS and thrombotic events.

  • Ankylosing Spondylitis
  • Cardiovascular Disease
  • Psoriatic Arthritis
  • Epidemiology

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  • Handling editor Tore K Kvien

  • Contributors JKE had full access to all of the data in the study and take responsibility for the accuracy of the data analysis. JA, JKE and LJ: trial design. JA, KB, JKE and LJ: quality control of data, analysis and interpretation of data and critical revision of the manuscript for important intellectual content. JA and JKE: drafting of the manuscript.

  • Funding This study was funded through grants from the Swedish Research Council, the Swedish Foundation for Strategic Research and from the Stockholm County Council (ALF).

  • Competing interests JA has received research grants from Pfizer, AstraZeneca, Merck and UCB in relation to work based on the Swedish Biologics Register ARTIS. JA and JE reported participating in research projects fully or partly funded by Novo Nordisk. JE had served as an external consultant to AbbVie.

  • Ethics approval Stockholm Ethics Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors have access to raw data for this study and may be contacted for inquiries. According to national data protection rules, these linked raw data cannot be distributed further.