title: Subclinical Atherosclerosis Is Not Accelerated in Patients with Ankylosing Spondylitis with Low Disease Activity: New Data and Metaanalysis of Published Studies.
abstract: OBJECTIVE
  Chronic inflammatory rheumatic diseases are associated with accelerated atherosclerosis, but data in ankylosing spondylitis (AS) are limited and the relative contribution of inflammation versus classical cardiovascular (CV) risk factors remains a matter of controversy. We addressed this in an original study and a metaanalysis of previous studies.
  
  
  METHODS
  Atheromatic plaques in carotid and femoral arteries, carotid hypertrophy [intima-media thickness (IMT), cross-sectional area], and carotid stiffness by ultrasound, as well as aortic stiffness by pulse wave velocity, were examined in consecutive nondiabetic, CV disease (CVD)-free patients with AS. Healthy individuals carefully matched 1:1 with patients for age, sex, smoking habits, hyperlipidemia, and hypertension served as controls. A metaanalysis of original studies that examined subclinical atherosclerosis in patients with AS versus controls with comparable CVD risk factors was also performed.
  
  
  RESULTS
  Carotid and femoral atheromatic plaques were slightly less prevalent compared with controls in a contemporary cohort consisting of 67 patients with AS (82% men), aged 47.5 ± 12.5 years (mean ± SD), with a median disease duration of 12 years and a Bath AS Disease Activity Index (BASDAI) of 1.8 (interquartile range 0.4-3.6), of whom 66% were receiving anti-tumor necrosis factor (TNF) treatment. Carotid hypertrophy and stiffness, as well as aortic stiffness, were similar between patients and their matched controls. Metaanalysis of all published studies revealed a significantly increased carotid IMT, but not plaque burden, in AS versus controls. Notably, however, increased IMT was not evident in studies involving patients with low disease activity (mean BASDAI < 4) or in those studies that included > 50% of patients treated with anti-TNF.
  
  
  CONCLUSIONS
  Low AS disease activity is not associated with accelerated atherosclerosis.
authors.affiliation: From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Arida
authors.affiliation: From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Protogerou
authors.affiliation: From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
authors.forename: George
authors.initials: G
authors.lastname: Konstantonis
authors.affiliation: From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
authors.forename: Maria
authors.initials: M
authors.lastname: Konsta
authors.affiliation: From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
authors.forename: Evi M
authors.initials: EM
authors.lastname: Delicha
authors.affiliation: From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School.
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.affiliation: From the Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital; Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School, Athens, Greece.A. Arida, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; A.D. Protogerou, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G. Konstantonis, MSc, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; M. Konsta, MD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; E.M. Delicha, PhD, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; G.D. Kitas, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School; P.P. Sfikakis, Professor, Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Laikon Hospital, and Joint Academic Rheumatology Programme, National Kapodistrian University of Athens Medical School. psfikakis@med.uoa.gr.
authors.forename: Petros P
authors.initials: PP
authors.lastname: Sfikakis
mesh_terms: D000328:Adult; D000367:Age Factors; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage*; D014655:Vascular Resistance / Q000187:drug effects*
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: ANKYLOSING SPONDYLITIS; ATHEROMATOSIS; ATHEROSCLEROSIS; CARDIOVASCULAR DISEASE