The flow-chart for enrolment is shown in Figureġ. The medical records of all AS patients registered in the hospitals’ databases were reviewed. Exclusion criteria were psoriasis, inflammatory bowel disease, dementia, pregnancy, other severe diseases such as malignancy and difficulties in answering questionnaires. All patients fulfilled the modified New York criteria’s for AS They were identified through the patient records at three different departments of Rheumatology in Sweden, in Gothenburg (Sahlgrenska University Hospital), Borås and Alingsås. The study cohort consists of 210 patients (120 men) with mean age (SD range) 49 (13 16–77) years. Furthermore, we assessed HLA B27 subtypes to explore any relation between cardiac involvement and specific subtypes. The present study was therefore initiated to test whether the Dutch results were reproducible in a cross-sectional study of a Swedish cohort of AS patients. Such data – if confirmed - have potential mechanistic and therapeutic implications. Although other factors such as age and gender also were associated with signs of cardiac involvement the data might be interpreted as supportive of a progressive inflammatory process including fibrosis. , a recent study focusing specifically on AS patients reported a relation between rheumatic disease characteristics and both AV and intra-ventricular conduction intervals Furthermore, and in contrast to some previous observations from SpA patients in general since AS is a more homogeneous disease contrary to SpA comprising different phenotypes. In the present study we focus on patients with AS fulfilling the modified New York criteria’s for AS The inflammatory process includes development of fibrosis, which according to one autopsy study might contribute to cardiac involvement Obliterative (occlusive) endarteritis of small vessels supplying the aortic root and the atrio-ventricular (AV) node is a salient histological feature just as was described in the vicinity of afflicted joints more than 50 years ago Typically cardiac involvement consists of conduction system abnormalities and/or aortic valve insufficiency which might require pacemaker therapy and valve replacement, respectively. There is a strong immuno-genetic link between spondylarthropathies, especially AS, and the Human Leukocyte Antigen (HLA) B27 and the associated inflammatory process might not only cause rheumatic disease but may also target cardiac function However, in a Brazilian registry study on SpA cardiac manifestations were infrequently found , and there is data demonstrating an increased risk of cardiovascular disease also in AS patients The situation is less clear for ankylosing spondylitis (AS) and the other spondylarthropathies (SpA) although cardiovascular diseases are the leading cause of death just as in the general population
Increased cardiovascular morbidity and mortality seems indisputable in rheumatoid arthritis and systemic lupus erythematosus seems to predispose for premature CAD, especially in younger women Chronic inflammatory disease has recently come into focus as a risk factor for the development of cardiovascular dysfunction including coronary artery disease (CAD)
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