This research must answer the following questions: (1) what is the prevalence of CVD in AS patients?(2) what is the incidence of CVD in patients with AS? (3) which risk factors contribute to the development of CVD in AS? (4) to which extent AS…
ID
Source
Brief title
Condition
- Cardiac disorders, signs and symptoms NEC
- Arteriosclerosis, stenosis, vascular insufficiency and necrosis
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
CVD will be defined as an objectified history of coronary, cerebral or
peripheral arterial disease. Coronary diseases will be defined as having a
history of myocardial infarction, surgery for ischemic heart disease.
Cerebrovascular disease is defined as a history of a transient ischemic attack,
a stroke, or a carotid endarterectomy. Peripheral arterial disease will be
defined as an aneurysm of the aorta abdominalis, peripheral arterial
reconstructive surgery, limb amputation.
Secondary outcome
Demographic data: age, gender, disease duration, disease onset, co-morbidity,
radiographic damage, medical history, medication history, family history.
AS disease activity: Bath Ankylosing Spondylitis Disease Activity Index
(BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing
Spondylitis Metrology Index (BASMI), Maastricht Ankylosing Spondylitis Enthesis
Score (MASES), Ankylosing Spondylitis (Asqol) scores, history of orthopedic
surgery, (history of) extra-articular manifestations.
Cardiovascular risk factors: smoking, family history of premature CVD, (history
of) hypertension, (history of) dyslipidemia, (history of) thyroid gland
failure, and diabetes mellitus.
Physical examination: blood pressure, pulse, height, length, body mass index
(BMI), waist circumference, hip circumference, waist hip ratio (WHI), ankle
branchial pressure index, EKG.
Laboratory: Erythrocyte sedimentation rate (ESR), C-reactive protein, glucose
(fasting), HbA1c, platelet counts, creatinine, thyroid stimulating hormone
(TSH), lipids (total cholesterol, HDL, TG, Apo-A, Apo-B).
Background summary
A limited number of studies indicate that (cardiovascular) mortality and
morbidity among patients with AS might be increased when compared with age- and
sex matched controls. Studies investigating mortality in AS show elevated
standardized mortality ratios (SMR*s) of approximately 1.6-1.9. Cardiovascular
disease (CVD) seems to be the major cause of this excessive mortality [1-5].
This postulated increased cardiovascular risk can only partially be explained
by an increased prevalence of traditional cardiovascular risk factors and/or
characteristic cardiac manifestations such as aortic insufficiency and
diastolic dysfunction [6,7]. Altogether, the precise magnitude of the
postulated increased cardiovascular risk in AS is not known.
Other inflammatory rheumatic diseases, such as rheumatoid arthritis (RA), are
already known to be associated with an increased cardiovascular risk in
comparison with the general population [8]. Data regarding cardiovascular risk
factors among patients with AS are limited and there are no data about the
relationship between inflammation and cardiovascular diseases in AS. This
postulated enhanced cardiovascular risk in AS could be caused by:
1. A higher prevalence of conventional cardiovascular risk factors in SpA, such
as smoking, atherogenic lipid profile, hypertension, diabetes mellitus, a high
body mass index, high levels of homocysteine, high levels of fibrinogen,
increased platelets, and hypercoagulability;
2. SpA is a risk factor for developing cardiovascular diseases, eg, due to:
a. Decreased physical activity;
b. Inflammation.
3. Undertreatment of cardiovascular comorbidity, eg, hypertension.
Alterations in the frequency of cardiovascular risk factors such as smoking,
abnormal lipid profile, hypertension, increased fibrinogen level, enhanced
number of platelets, and hypercoagulability may contribute to the higher
cardiovascular risk in patients with AS. In addition, deterioration of physical
function, and inflammation may also contribute to cardiovascular risk. Chronic
inflammation may act independently or synergistically with other cardiovascular
risk factors in the pathogenesis of atherosclerosis [9]. Recent research has
shown that systemic inflammation plays a pivotal role in the development of
atherosclerosis [10,11]. Immune cells dominate early atherosclerotic lesions,
their effector molecules accelerate progression of the lesions and inflammation
elicits CVD. Hence, inflammation is thought to be the key risk factor
explaining the increased cardiovascular risk in patients with AS. The finding
that the increased mortality is dependent upon disease severity supports this
idea [12]. Finally, we should be aware of the potential existence of
underrecognition and undertreatment of cardiovascular morbidity, which may lead
to higher cardiovascular risk [13].
Until now, data regarding the cardiovascular risk profile in patients with AS
are limited and inconclusive. There is accumulating evidence for a higher
prevalence of CVD due to atherosclerosis, but studies investigating this topic
are lacking.
Study objective
This research must answer the following questions:
(1) what is the prevalence of CVD in AS patients?
(2) what is the incidence of CVD in patients with AS?
(3) which risk factors contribute to the development of CVD in AS?
(4) to which extent AS influences the cardiovascular risk?
Study design
A multi-centre cohort study with a nested case control design. A cardiovascular
questionnaire will be sent to all registered AS patients aged 50-75 years in
the Jan van Breemen Clinics as well as in the VU university medical centre.
Each respondent with a history of CVD will be invited at the Jan van Breemen
Clinics and an equal age and sex matched AS patient will be added and they will
be invited at the Jan van Breemen Clinics also. This procedure will be repeated
yearly and included patients will be followed for at least 5 years.
Study burden and risks
Risk: none
Benefit: Cardiovascular disease (CVD) seems to be the major cause of the excess
morbidity and mortality in patients with AS, which is partly due to
atherosclerosis. Inflammation is thought to play a pivotal role in the
development of atherosclerosis. As in other autoimmune diseases it is important
to explore the cardiovascular burden in AS as well as potential targets for
intervention to lower this risk and decrease mortality due to AS.
Dr. Jan van Breemenstraat 2
1056 AB Amsterdam
NL
Dr. Jan van Breemenstraat 2
1056 AB Amsterdam
NL
Listed location countries
Age
Inclusion criteria
- Patients with AS (according to the modified New York criteria);
- aged 50 years and older;
- registered at the Jan van Breemen Institute and/or the VU university medical center.
Exclusion criteria
none
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL15378.048.07 |