title: Sulfasalazine might reduce risk of cardiovascular diseases in patients with ankylosing spondylitis: A nationwide population-based retrospective cohort study.
abstract: OBJECTIVE
  To assess the effects of celecoxib and sulfasalazine on cardiovascular risk in patients with ankylosing spondylitis (AS).
  
  
  METHODS
  We performed a 10-year population-based retrospective cohort study. A total of 1208 AS patients and 19 328 non-AS patients were sampled from the Taiwan National Health Insurance (NHI) database. We compared these two groups of patients to identify the differences in the exposure of non-steroidal anti-inflammatory drugs and sulfasalazine and their effects on cardiovascular risk. Univariate analyses were performed using Chi-squared tests for dichotomous variables and t-tests for continuous variables. Cox proportional hazard models were conducted to investigate the risk of developing cardiovascular diseases (CVD).
  
  
  RESULTS
  AS patients had an adjusted hazard ratio (HR) of 1.72 (CI = 1.46-2.02, P < 0.01) for CVD compared with non-AS controls. The risk increased significantly with the progression of the disease. The use of celecoxib and sulfasalazine provided protective effects against CVD in both groups of patients. Both drugs at high cumulative defined daily doses (DDD) and celecoxib alone at high cumulative DDD showed significant protective effects against CVD in AS patients and the control group, respectively. Sulfasalazine at ≥ 0.5 DDD (1000 mg/day) reduced CVD risk in patients with AS (HR = 0.65, CI = 0.43-0.998, P < 0.05).
  
  
  CONCLUSIONS
  In this population-based retrospective cohort study, sulfasalazine at its optimal dose reduced CVD risk in patients with AS. Celecoxib was neutral regarding CVD risk in AS patients.
authors.affiliation: School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Tam
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Tai Chung, Taiwan.|Institute of Medicine, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: Kai-Jieh
authors.initials: KJ
authors.lastname: Yeo
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Tai Chung, Taiwan.|Institute of Medicine, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: Pui-Ying
authors.initials: PY
authors.lastname: Leong
authors.affiliation: School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: Chao-Hsi
authors.initials: CH
authors.lastname: Chen
authors.affiliation: School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: Yuan-Chao
authors.initials: YC
authors.lastname: Li
authors.affiliation: School of Medicine, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Ma
authors.affiliation: Department of Medical Research, Chung Shan Medical University Hospital, Tai Chung, Taiwan.
authors.forename: Yu-Hsun
authors.initials: YH
authors.lastname: Wang
authors.affiliation: School of Health Policy and Management, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: Jeng-Yuan
authors.initials: JY
authors.lastname: Chiou
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Tai Chung, Taiwan.|Institute of Medicine, Chung Shan Medical University, Tai Chung, Taiwan.
authors.forename: James Cheng-Chung
authors.initials: JC
authors.lastname: Wei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D000068579:Celecoxib / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012460:Sulfasalazine / Q000009:adverse effects / Q000627:therapeutic use*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D012460:Sulfasalazine; D000068579:Celecoxib
keywords: Taiwan National Health Insurance database; ankylosing spondylitis; cardiovascular disease; celecoxib; defined daily dose; sulfasalazine