Ankylosing spondylitis and heart disease: What to know

According to the Centers for Disease Control and Prevention (CDC), heart disease is a broad term that encompasses several different conditions.

The Spondylitis Association of America (SAA) note that AS can increase a person’s risk of several cardiac conditions. These include:

• ischemic heart disease, which occurs when there is not enough blood flow to the heart and can bring on symptoms such as chest pressure, angina, and a low tolerance for activity
• conduction disturbances that can cause the heart to beat too slowly or quickly
• cardiomyopathy, which is an enlargement and weakening of the heart
• aortitis, which is inflammation of the aorta

Cardiac involvement can also include aortic insufficiency and cardiac heart conduction disturbances.

Heart disease alone contributes to about 1 in 4 deaths in the United States. A 2017 study found that people living with AS are 30–50% more likely than those without the condition to experience a cardiovascular event, such as a heart attack or stroke.

Although scientists do not yet fully understand the connection between AS and the heart, there are two main theories regarding the link. We look at these below.

Chronic inflammation

The Arthritis Foundation state that any health condition, including inflammatory arthritis, can strain the heart over time. Having inflammatory arthritis can increase the risk of:

• heart attack
• stroke
• atrial fibrillation, or an irregular heartbeat
• atherosclerosis, which refers to the buildup of plaque in the arteries
• high blood pressure
• heart failure

In a 2015 review of studies, researchers looked at the number of people with AS who also had coronary artery disease. They found that people living with AS had a significantly increased risk of developing coronary artery disease in comparison with the general population.

The researchers involved in this review were unclear on the association between AS and heart disease. However, they did state that a possible link is the long-term effect of chronic inflammation on the heart.

Genetic factors

In a 2018 study, researchers looked at the prevalence of comorbidities associated with AS in 6,679 people aged 18 years and over. In comparison with a control group, people with AS had higher rates of the following cardiovascular diseases:

• angina
• myocardial infarction, or heart attack
• atherosclerosis
• cerebrovascular disease or stroke
• venous thromboembolism
• coronary artery disease
• hypertension, or high blood pressure

Although the researchers did not specifically look at potential causes, they stated that genetic connections might be responsible for the higher rates of cardiovascular disease in those with AS. They also stated that the commonalities between both conditions might make AS a marker for heart disease.

The author of a 2016 article argued that people with AS are at higher risk both of developing heart disease and of death related to the effects that AS has on the cardiovascular system.

As a result, the author warns that people with AS should seek emergency medical attention if they develop chest discomfort or any sensation of an irregular heartbeat. Study findings suggest that this is especially urgent for those with the HLA-B27 gene, which experts believe to play a role in the development of AS.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a standard treatment for AS. Examples of NSAIDs include ibuprofen (Advil) and naproxen (Aleve). Reports show that these medications are associated with an increased risk of cardiovascular events.

According to the SAA, several studies indicate that the long-term use of NSAIDs increases the risk of cardiovascular events, such as heart attack.

However, in a 2015 study involving more than 400 people living with AS, researchers found that infrequent use of NSAIDs presented a higher risk of cardiac events than regular, long-term use.

The study authors noted a significantly reduced risk of cardiac events after 12 months of NSAID use. They took these findings as evidence that long-term use of NSAIDs is safe for people living with AS.

However, since 2005, the Food and Drug Administration (FDA) have warned of the increased risk of heart attack and stroke with the use of NSAIDs. In 2015, they issued an updated statement strengthening this warning.

Prednisone, another medication that doctors use in the management of AS, may also pose a risk. This medication is known to raise blood pressure and cholesterol levels and contribute to atherosclerosis.

On the other hand, many disease-modifying drugs, including methotrexate and biologic drugs for AS, help reduce inflammation in the body. This effect may help protect the heart.

As part of the process of putting a treatment plan in place for AS, a person should talk with their doctor about their risk factors for cardiac events. The doctor can help assess the person’s risk factors and recommend an appropriate course of treatment.

A person living with AS may be at higher risk of developing heart disease, but that does not mean that they cannot take steps to help prevent it.

The SAA suggest that a person take the following steps to protect their heart health:

• quitting or avoiding smoking
• eating a healthful diet
• maintaining a moderate weight
• engaging in regular exercise
• remaining consistent with treatments for AS

The Arthritis Foundation state that exercise can be particularly challenging for people living with arthritis, due to symptoms such as joint pain. They suggest working with a doctor or physical therapist to develop an exercise routine that does not cause unnecessary pain.

Regular doctor visits should be part of all AS management plans. A person can speak with their doctor about their risk of other conditions, such as heart disease, and discuss plans to protect their health.

A person’s doctor can recommend any necessary lifestyle adjustments, such as exercising more frequently or making dietary changes. They can also help monitor a person’s heart health by regularly testing their blood pressure and cholesterol levels and checking the heart for irregularities.

A person should seek emergency medical attention if they experience any symptoms of a heart attack or stroke.

A person living with AS is at a higher risk of developing cardiac disease. Scientists think that this may be due to the underlying inflammatory activity, as well as genetic links.

A person can take preventive steps, such as maintaining a moderate weight, eating a healthful diet, and exercising regularly. A person should talk with their doctor regularly about treating their AS. Monitoring any risk factors for cardiovascular disease should also be part of their treatment plan.