Pos0658 ankylosing spondylitis is associated with increased prevalence of valvular heart diseases: a population based study

Background Ankylosing spondylitis (AS) is a chronic inflammatory arthritis primarily affecting the sacroiliac joint and axial skeleton with associated extraarticular involvement including cardiovascular system disease including aortic value disease with variable reported prevalence. Objectives The aim of this study is to determine the prevalence of heart valve disorders in AS patients. Methods A retrospective, population-based, cross-sectional study retrieved from the Clalit Health Services (CHS) registry. Cases were defined as having AS, whereas controls were age- and sex- frequency matched in a ratio of 5:1. The prevalence of valvular heart diseases was compared between the two groups, a multivariate logistic regression model was applied to estimate the association after controlling for potential confounders. Results We included 4,082 AS patients and 20,397 age- and sex- frequency matched controls. AS patients had a significantly higher prevalence of cardiovascular risk factors (p<0.001) and a higher prevalence of valvular heart disease. In the multivariate logistic regression model, adjusting for multiple confounding factors, AS was independently associated with aortic stenosis (OR 2.25, 95% CI 1.57-3.23, p<0.001), aortic insufficiency (OR 2.44, 95%CI 1.5-3.94, p<0.001), mitral insufficiency (OR 1.75, 95%CI 1.17-2.61, p<0.001) but not mitral stenosis (OR 1.31, 95% CI 0.6-2.7, p=0.47). Conclusion Our study reports the increased risk of valvular heart diseases in patients with AS possibly due to the inflammatory milieu associated with the disease process and the result of biomechanical stress affecting the enthesis-like valvular structures. Reference [1]Dubash S, McGonagle D, Marzo-Ortega H. New advances in the understanding and treatment of axial spondyloarthritis: from chance to choice. Ther Adv Chronic Dis. 2018;9:77-87 Table 1. Characteristics of the study population of the present study Control (N=20397) Ankylosing spondylitis (N=4082) p-value Age 56.5 (41.0-66.0) 54.9 (42.0-67.0) 0.065 Sex Male 13032 (63.9%) 2608 (63.9%) 0.999 Female 7365 (36.1%) 1474 (36.1% Smoking 3647 (17.9%) 1873 (45.9%) Comorbidities Obesity 2124 (10.4%) 1196 (29.3%) <0.001 Hypertension 3021 (14.8%) 1499 (36.7%) <0.001 Diabetes 1800 (8.8%) 885 (21.7%) <0.001 Hyperlipidemia 4513 (22.1%) 2237 (54.8%) <0.001 Ischemic heart disease 1290 (6.3%) 574 (14.1%) <0.001 Pulmonary Hypertension 130 (0.6%) 47 (1.2%) <0.001 Treatment <0.001 NSAIDs 7881 (98.5%) 2257 (56.4%) DMARDS 101 (1.3%) 538 (13.4%) Anti-TNF 19 (0.2%) 1210 (30.2%) Valvular heart disease Aortic Stenosis 71 (0.3%) 61 (1.5%) <0.001 Aortic Insufficiency 71 (0.3%) 46 (1.1%) <0.001 Mitral Stenosis 28 (0.1%) 11 (0.3%) 0.053 Mitral Insufficiency 80 (0.4%) 46 (1.1%) <0.001 Abbreviations – NSAIDs- non-steroidal anti-inflammatory drugs; anti-TNF – anti-tumour necrosis factor; DMARDs – disease modifying antirheumatic drugs Figure 1. Logistic regression model showing the association of Ankylosing spondylitis with various heart valvular disease Acknowledgements: NIL. Disclosure of Interests None Declared.