AB1657 TIME-DEPENDENT CSDMARDS USE AND INFLAMMATORY BURDEN CAN PREDICT CARDIOVASCULAR RISK IN PATIENTS WITH ANKYLOSING SPONDYLITIS:A POPULATION-BASED STUDY

Abstract

BackgroundIt is well established that AS patients had a higher risk of cardiovascular disease (CVD) than the general population [1,2]. To date, there is no primary studies directly addressing the relationship between risk factors and MACE in population-level study.ObjectivesTo examine whether inflammatory burden and drug use over time increase major adverse cardiovascular events (MACE) independent of traditional cardiovascular (CV) risk factors in ankylosing spondylitis (AS) patients.MethodsPatients who had been diagnosed with AS (ICD-9: 720.0) from 2006 to 2015 were recruited in a retrospective cohort study. They were followed until the end of 2018. The primary outcome was a first incidence of MACE. Time-varying Cox proportional hazard models were used to assess whether inflammatory burden (c-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]), and drug use (non-steroidal anti-inflammatory drugs [NSAIDs] and disease modifying anti-rheumatic drugs [DMARDs]) can predict the development of first MACE.ResultsTotally 3827 patients (age: 45.2 ± 15.0 years, male: 2911 [76.1%]) were recruited. 135 patients (13.2%) developed a first MACE. ESR level (including ESR≥20 mm/h and ESR≥30mm/h, HR: 2.07-2.41), CRP level (including CRP>3 mg/dl, HR: 1.20-8.77) and use of steroid (HR: 3.48) were associated with a significantly higher risk of MACE during follow-up. Whereas the use of sulfasalazine (SLZ), bDMARDs and non-COXII inhibitor were associated with reduced risk of MACE. After adjusting for time-fixed CV risk scores in the multivariable models, only ESR level (including ESR≥30 mm/h, HR: 1.02-1.94) and CRP level (including CRP>3 mg/dl, HR: 1.14-5.43) remained significant predictor for increased risk of MACE, while SLZ (HR: 0.41-0.52) was protective against MACE.ConclusionIncreased inflammatory burden was associated with increased risk of MACE, while the use of SLZ may reduce risk of future MACE in patients with AS.