title: Ankylosing spondylitis and risk of ischaemic heart disease: a population-based cohort study.
abstract: OBJECTIVE
  To investigate the incidence and risk of ischaemic heart disease (IHD) and acute myocardial infarction (AMI), including the role of non-steroidal anti-inflammatory drugs (NSAID), in patients with ankylosing spondylitis (AS) compared with population controls.
  
  
  METHODS
  All patients with newly diagnosed AS (n=3809) from the British Clinical Practice Research Datalink (1987-2012) were matched with up to seven persons without AS by year of birth, gender and practice (n=26 197). Incidence rate ratios (IRR) and HRs for development of IHD and AMI were calculated. Stepwise analyses were performed adjusting for age, gender, comorbidity and drug use, including NSAIDs.
  
  
  RESULTS
  At baseline, 4.3% of the patients had IHD and 1.8% had AMI compared with 3.4% and 1.4% of the controls, respectively. After exclusion of pre-existing IHD or AMI, the IRRs were 1.18 (95% CI 0.96 to 1.46) and 0.91 (95% CI 0.65 to 1.27) for IHD and AMI, respectively. Compared with controls, the age-gender adjusted HR for developing IHD was 1.20 (95% CI 0.97 to 1.48), and for AMI 0.91 (95% CI 0.65 to 1.28). In female patients, the risk of developing IHD was increased (HR 1.88, 95% CI 1.22 to 2.90), but after adjustment for all possible risk factors only a non-significant trend was found (HR 1.31, 95% CI 0.83 to 2.08). In particular, NSAID use explained this change (HR IHD adjusted for age-gender-NSAID use 1.57, 95% CI 0.99 to 2.48).
  
  
  CONCLUSIONS
  Female patients with AS had an increased age-adjusted risk of developing IHD, but after adjustment for NSAID use only a non-significant trend towards increased risk was found.
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
authors.forename: Ivette
authors.initials: I
authors.lastname: Essers
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stolwijk
authors.affiliation: Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.
authors.forename: Marie L
authors.initials: ML
authors.lastname: De Bruin
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands.
authors.forename: Marloes T
authors.initials: MT
authors.lastname: Bazelier
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: de Vries
authors.affiliation: Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: van Tubergen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal