Pos0956 high inflammatory burden predicts cardiovascular events in patients with axial spondyloarthritis: a long-term follow-up study

BackgroundAxial spondyloarthritis (axSpA) patients had a higher risk of cardiovascular disease (CVD) than the general population (1). It is also suggested that inflammation, rather than a particular disease, drives the increased risk of CVD (2). But the relationship between inflammation in axSpA and CVD is unknown.ObjectivesTo examine whether inflammatory burden over time can predict cardiovascular events (CVE) independent of baseline CV risk factors in axial spondyloarthritis (axSpA) patients.MethodsA cohort analysis was performed in patients who had been recruited since January 2001. The primary outcome was a first CVE occurring between January 2001 and December 2020. Three CVD risk scores were computed at baseline. The performance of the original and modified (x 1.5 multiplication factor) CV risk algorithms were assessed. Time-varying Cox proportional hazard models and Kaplan-Meier survival analysis were used to assess whether inflammatory burden (Bath ankylosing spondylitis disease activity index [BASDAI] and inflammatory markers), non-steroidal anti-inflammatory drugs (NSAIDs) and disease modifying anti-rheumatic drugs (DMARDs) can predict the development of first CVE.Results463 patients [35(26-45) years, male: 360(77.8%)] were recruited. After a median follow up of 12 (7-19) years, 61 patients (13.2%) experienced a first CVE. Traditional/modified CV risk scores underestimated CV risk. Erythrocyte sedimentation rate (ESR)≥20 mm/hr was associated with a significantly higher risk of CVE during follow-up [HR: 2.07, 95%CI (1.10, 3.98), p=0.008]. Active disease as indicated by a rising BASDAI also showed positive trend towards a higher risk of developing CVE over time. After adjusting for CV risk scores in the multivariable models, high ESR level (ESR≥20 mm/hr) over time remained significantly associated with a higher risk of developing CV events (Table 1a and 1b). A significant difference in the CV event-free survival between patients with ESR≥20 mm/hr and ESR<20 mm/hr was demonstrated in Figure 1.Table 1.Multivariable analysis with time-dependent Cox proportional hazard regression for the predictors of cardiovascular events.Figure 1.Kaplan-Meier survival analysis between time-varying ESR level and CVE. P=0.006 for difference in CVE-free survival rate between patients with ESR≥20mm/hr and ESR<20mm/hr during their follow-up intervals. ESR: Erythrocyte Sedimentation Rate.ConclusionIncreased inflammatory burden as reflected by elevated ESR levels (ESR≥20) was associated with increased risk of CVE, while the use of NSAIDs and DMARDs were not.References[1]Exarchou, S., et al., Mortality in ankylosing spondylitis: results from a nationwide population-based study. Ann Rheum Dis, 2016. 75(8): p. 1466-72.[2]Lauper, K., et al., Incidence and Prevalence of Major Adverse Cardiovascular Events in Rheumatoid Arthritis, Psoriatic Arthritis, and Axial Spondyloarthritis. Arthritis Care & Research, 2018. 70(12): p. 1756-1763.Table 1a.Model 1Model 2Model 3Time-dependent HR (95%CI)p-valueTime-dependent HR (95%CI)P-valueTime-dependent HR (95%CI)P-valueESR≥202.75 (1.23, 6.14)0.014*2.74 (1.21, 6.21)0.016*2.93 (1.31, 6.57)0.009*BASDAI1.07 (0.90, 1.28)0.4551.06 (0.88, 1.28)0.5191.07 (0.89, 1.28)0.442FRS1.06 (1.03, 1.09)<0.001*QRISK31.05 (0.99, 1.11)0.132SCORE1.25 (1.09, 1.42)0.001*Table 1b.Model 1Model 2Model 3Time-dependent HR (95%CI)P-valueTime-dependent HR (95%CI)P-valueTime-dependent HR (95%CI)P-valueESR≥202.77 (1.24, 6.18)0.013*2.78 (1.23, 6.28)0.014*2.95 (1.32, 6.59)0.008*BASDAI≥41.37 (0.62, 2.99)0.4341.26 (0.58, 2.78)0.5591.42 (0.65, 3.09)0.376FRS1.06 (1.03, 1.09)<0.001*QRISK31.05 (0.99, 1.11)0.138SCORE1.24 (1.09, 1.42)0.001**Statistically significant at p≤0.05.HR, hazard ratio; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; CRP: C-Reactive Protein; ESR: Erythrocyte Sedimentation Rate; FRS: Framingham Risk Score; SCORE: Systematic Coronary Risk Evaluation.AcknowledgementsWe would like to show our gratitude to all medical staffs, research assistants.Disclosure of InterestsNone declared