title: Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Rheumatoid arthritis is associated with increased cardiovascular risk. In ankylosing spondylitis (AS), there is a paucity of information concerning this risk. Our objective was to assess the incidence of myocardial infarction (MI) or strokes and the cardiovascular risk profile in AS patients.
  
  
  METHODS
  We performed a systematic literature review using PubMed, EMBase, and the Cochrane Library up to August 2009. Incidence of MI or stroke was calculated by metaproportion. For cardiovascular risk factors, differences between AS patients and controls were expressed by standardized mean differences using inverse of variance method.
  
  
  RESULTS
  For MI, 8 longitudinal studies were included. In controls (n=82,745), 1,318 MI cases were observed (4.6%; 95% confidence interval [95% CI] 1.2%, 10.0%). In AS patients (n=3,279), 224 MI cases were reported (incidence 7.4%; 95% CI 5.2%, 10.0%). The increase in MI cases in AS patients was not significant (risk ratio 1.88; 95% CI 0.83, 4.28). For stroke, 7 longitudinal studies reported 327 strokes in AS patients (n=31,949), which is an incidence of 2.2% (95% CI 1.3%, 3.4%). In controls (n=7,372), one study reported 170 strokes (2.3%; 95% CI 2.0%, 2.7%). For cardiovascular risk factors, 15 case-control studies and 9 abstracts were included (n=1,214 for patients and n=1,000 for controls). AS patients were characterized by a higher weighted mean intima-media thickness and higher risk of metabolic syndrome. In AS patients, there was a significant decrease in triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol.
  
  
  CONCLUSIONS
  AS patients appear to be at higher risk of MI, which could be due to low HDL cholesterol levels or to systemic inflammation. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS.
authors.affiliation: Clermont 1 University, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France. smathieu@chu-clermontferrand.fr
authors.forename: Sylvain
authors.initials: S
authors.lastname: Mathieu
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008076:Cholesterol, HDL / Q000097:blood; D006801:Humans; D008137:Longitudinal Studies / Q000639:trends; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000097:blood / Q000150:complications* / Q000453:epidemiology*
chemical_list: D008076:Cholesterol, HDL