title: Cardiovascular risk management in patients with active ankylosing spondylitis: a detailed evaluation.
abstract: BACKGROUND
  Ankylosing spondylitis (AS) is an inflammatory disease with documented elevated cardiovascular (CV) risk due to systemic inflammation and a higher prevalence of CV risk factors. CV risk management (CV-RM) could be an effective method to reduce CV mortality and morbidity in AS patients. We assessed CV risk and evaluated guideline adherence according to the Dutch CV-RM guideline.
  
  
  METHODS
  This study was conducted with a cohort of consecutive AS patients eligible for treatment with a tumor necrosis factor (TNF) -α inhibitor. Data from the Dutch National Institute for Public Health and Environment was used to compare the prevalence of CV risk factors in AS patients with the Dutch background population.
  
  
  RESULTS
  In total, 254 consecutive AS patients were included. The prevalences of hypertension (41% vs 31%) and smoking (43% vs 27%) were substantially higher in AS patients as compared to the general Dutch background population. Of 138 AS patients older than 40 years the 10-years CV risk could be calculated. Fifty-one of these 138 patients (37%) had an indication for CV risk treatment. CV risk treatment was initiated in 42 of the 51 (82%), however, in only 12 of the 51 (24%) patients treatment targets for either hypertension or hypercholesterolemia were reached.
  
  
  CONCLUSIONS
  The increased rates of hypertension and smoking illustrate the importance of CV-RM in AS patients. Although the majority of all AS patients eligible for CV-RM received CV risk medication, CV-RM remains a challenge for treating physicians, as treatment targets were not achieved in three-quarter of the eligible patients.
authors.affiliation: Department of Rheumatology, Reade, Amsterdam, Netherlands. s.heslinga@reade.nl.|Department of Rheumatology, VU University Medical Centre, Amsterdam, Netherlands. s.heslinga@reade.nl.|Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands. s.heslinga@reade.nl.
authors.forename: Sjoerd C
authors.initials: SC
authors.lastname: Heslinga
authors.affiliation: Department of Rheumatology, Reade, Amsterdam, Netherlands. i.vd.oever@reade.nl.|Department of Rheumatology, VU University Medical Centre, Amsterdam, Netherlands. i.vd.oever@reade.nl.
authors.forename: Inge A
authors.initials: IA
authors.lastname: Van den Oever
authors.affiliation: Department of Rheumatology, Reade, Amsterdam, Netherlands. a.v.sijl@reade.nl.|Department of Rheumatology, VU University Medical Centre, Amsterdam, Netherlands. a.v.sijl@reade.nl.|Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands. a.v.sijl@reade.nl.
authors.forename: Alper M
authors.initials: AM
authors.lastname: Van Sijl
authors.affiliation: Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands. mjl.peters@vumc.nl.
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Peters
authors.affiliation: Department of Rheumatology, Reade, Amsterdam, Netherlands. ie.vanderhorst@vumc.nl.|Department of Rheumatology, VU University Medical Centre, Amsterdam, Netherlands. ie.vanderhorst@vumc.nl.
authors.forename: Irene E
authors.initials: IE
authors.lastname: Van der Horst-Bruinsma
authors.affiliation: Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands. y.smulders@vumc.nl.
authors.forename: Yvo M
authors.initials: YM
authors.lastname: Smulders
authors.affiliation: Department of Rheumatology, Reade, Amsterdam, Netherlands. m.nurmohamed@reade.nl.|Department of Rheumatology, VU University Medical Centre, Amsterdam, Netherlands. m.nurmohamed@reade.nl.|Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands. m.nurmohamed@reade.nl.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010349:Patient Compliance; D015995:Prevalence; D012307:Risk Factors; D012308:Risk Management / Q000639:trends*; D012907:Smoking / Q000009:adverse effects; D013167:Spondylitis, Ankylosing / Q000150:complications*