According to a growing body of evidence, one harmful outcome linked to AS is an increased risk for heart disease. While estimates of the prevalence of heart disease in people with ankylosing spondylitis vary, several studies have found a significantly higher risk than in the general population. One large study that included 4,076 people with ankylosing spondylitis along with 20,290 age- and gender-matched people without AS — published in February 2018 in the journal Clinical Rheumatology — found that 14.1 percent of people with AS had ischemic heart disease, compared with 6.36 percent of those without AS. But an analysis of risk factors found that this increased risk for heart disease could be completely explained by rates of high blood pressure, high cholesterol and triglycerides, diabetes, smoking, and other known risk factors for heart disease. That analysis suggests you’re not powerless in the face of heart disease if you have ankylosing spondylitis: Taking control of your heart disease risk factors may help protect you. RELATED: 5 Health Conditions Related to Ankylosing Spondylitis
Inflammation May Account for Higher Heart Disease Risk
Ankylosing spondylitis is characterized by inflammation in certain joints — mainly the sacroiliac joints (where the spine attaches to the pelvis), the spine, and the hips. Typically in AS, low back pain and stiffness get worse after inactivity or sleep, with greater symptoms when you wake up in the morning and fewer after you move or exercise. The same inflammation that causes this pain and stiffness may also be responsible for the elevated heart risks seen in people with AS. Ankylosing spondylitis isn’t the only form of arthritis linked to heart disease, according to David Pisetsky, MD, a rheumatologist and professor of medicine at the Duke University School of Medicine in Durham, North Carolina. “Most rheumatic diseases are associated with increased risk for cardiovascular disease,” Dr. Pisetsky says. “Like AS, rheumatoid arthritis, psoriasis, and lupus all have inflammatory components, and when the immune system gets inflamed, it may play out in the cardiovascular system as much as the joints.” RELATED: Ankylosing Spondylitis: 9 Ways to Reduce Inflammation For example, some of the medications used to treat ankylosing spondylitis, such as non-steroidal anti-inflammatory drugs (NSAIDs), may also increase the risk for heart disease. “It’s a bit of a vicious cycle” when it comes to inflammation, heart disease, and AS treatments, says Susan Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City. “The inflammation raises the risk for heart disease, and the treatments to reduce the inflammation also place a person at increased risk,” Dr. Goodman says. Regular exercise is known to reduce a person’s heart disease risk, but if AS pain keeps you from exercising, it may be difficult to get this important benefit. People with ankylosing spondylitis are also more likely to have high cholesterol and high blood sugar (hyperglycemia) and to be overweight or obese — all factors that further increase heart disease risk, Goodman says. RELATED: 7 Reasons Exercise Is Good for Ankylosing Spondylitis
Reduce Your Risk: Take Care of Your Heart
While research on ways to combat heart disease in people with ankylosing spondylitis is ongoing, the best thing you can do for your heart right now is to stay on top of your heart disease risk factors. This includes regular visits with both a rheumatologist and a cardiologist, says Eric L. Matteson, MD, a rheumatologist and professor emeritus of medicine at the Mayo Clinic in Rochester, Minnesota. But even if you see your doctors as recommended, it’s still up to you to take steps to reduce your heart risk. “Get control of blood fats and cholesterol, minimize your use of NSAIDs where possible, and exercise if you can,” Dr. Matteson advises. “Don’t smoke. If you do, quit.” Smoking is a major risk factor for heart disease and is absolutely contraindicated in people with AS, according to the Spondylitis Association of America (SAA). Ankylosing spondylitis increases the risk for aortitis, among other types of heart disease, according to the SAA. Inflammation of the aorta — the heart’s main artery to the rest of the body — may cause problems with the heart’s aortic valve. “Go for routine stress tests so your doctor can listen for any abnormal heart sounds that could indicate problems with the aorta,” Matteson recommends. Not everyone with ankylosing spondylitis has the same risk factors for heart disease, emphasizes Suzanne Steinbaum, DO, a cardiologist with a private practice in New York City. “It is extremely important that you know your risk factors and your family history,” she says. “And be really aggressive about managing all of the known risk factors.” Additional reporting by Quinn Phillips.
