Inflammation tied to cardiovascular disease risk in axSpA patients
Sex differences in terms of risk also seen in study involving 913 patients
Inflammation in people with axial spondyloarthritis (axSpA), which includes ankylosing spondylitis, is linked to multiple risk factors for cardiovascular disease, with differences evident between men and women, a Spanish study found.
Cardiovascular disease refers to a group of conditions affecting the heart and blood vessels, ranging from arrhythmias and heart failure to stroke.
Men with high inflammation levels had lower “good” cholesterol levels, while women had higher triglycerides, a type of blood fat, and a stronger link between inflammation and insulin resistance. Insulin resistance, which occurs when the body stops responding to insulin, a hormone that helps sugar move into cells for energy, causes blood-sugar levels to rise and can lead to diabetes.
“The sex differences identified in this regard could help explain the greater excess [cardiovascular] risk that is usually observed in women with inflammatory diseases,” the researchers wrote, adding that this sex finding — noted as being seen for a first time — could lead to more personalized disease management.
Study into inflammation’s effects with diseases like ankylosing spondylitis
The study, “Sex-specific impact of inflammation on traditional cardiovascular risk factors and atherosclerosis in axial spondyloarthritis. A multicentre study of 913 patients,” was published in RMD Open.
In axSpA, the spine and the sacroiliac joints, which link the spine to the pelvis, become inflamed and damaged, causing disease symptoms such as back pain. In radiographic axSpA, or ankylosing spondylitis, those changes can be seen on an X-ray.
Inflammation is known to play a key role in how atherosclerosis (the buildup of fats, cholesterol, and other molecules in and on the artery walls, forming plaques) develops in people with inflammatory joint diseases. However, its link to cardiovascular disease in people with axSpA — and whether it differs according to a person’s sex — isn’t well understood.
The study included 611 men and 302 women with a diagnosis of axSpA, recruited at hospitals across the country. Data on cardiovascular risk factors were collected at two times: When each patient’s disease was diagnosed and later when they joined the study. Data on disease activity levels, how they affected daily function, and ultrasound scans of the carotid arteries (in the neck) were collected at study entry.
Disease duration from diagnosis to study enrollment was a mean of nearly 13 years for men and 10 years for women.
Patients with high levels of inflammation markers, called acute phase reactants (APRs), at diagnosis were more likely to develop high blood pressure and obesity over time. For men, APRs were associated with abnormal blood fats, while for women, high APRs linked with diabetes.
Inflammation levels altered ‘good’ cholesterol in men, triglycerides in women
When the patients joined the study, cardiovascular disease risk factors linked with both inflammation levels and how active and disabling the disease was. This link varied between men and women.
In men, higher levels of an inflammation marker called C-reactive protein (CRP) associated with lower high-density lipoprotein cholesterol, also known as HDL or “good” cholesterol because it removes unused cholesterol from the body.
In women, higher levels of another inflammation marker, called the erythrocyte sedimentation rate, linked with higher levels of triglycerides. Moreover, women alone showed a link between inflammation and insulin resistance.
The researchers also looked at carotid plaques, which are fatty deposits in the arteries of the neck that can lead to atherosclerosis. They found that men and women with high CRP levels at diagnosis and at high or very high risk of cardiovascular disease were more likely to have plaques than did patients with normal CRP levels.
“Our results highlight the importance of carrying out adequate primary prevention of [cardiovascular] disease in men and women with inflammatory diseases that allow us to keep classic [cardiovascular] factors under control and support the need to achieve strict control of inflammation,” the researchers wrote.
“The considerably lower proportion of women compared with men could be an additional limitation which would explain that some associations common to both sexes were statistically significant only in men,” they added. “Further studies with a higher female representation are necessary to clarify this point.”
