Dr. Nisha Nigil Haroon presented compelling evidence today that CV risk is significantly increased in patients with AS. Interestingly, her study also suggested a cardioprotective effect of NSAIDs, which runs counter to conventional CV risk factors for the general population.
In this population-based study, 21,473 incident cases of AS in patients aged 15 and older were included. Each case was matched to 4 controls for age, gender and residence. Billing codes were used to identify cases and outcomes. In a secondary analysis, those aged 65 or older were separately examined to assess the effect of NSAIDs, coxibs, antihypertensives and statins.
The adjusted hazard ratio (HR) for cerebrovascular mortality was 1.60, and for CV mortality the HR was 1.35. The latter suggests a 35% increased risk in those with AS compared to their matched controls, a statistically significantly value.
In the secondary analysis of patients aged 65 or older, the adjusted HR for CV mortality was 1.39. Significant risk factors included age, male sex, lower income, and dementia. The most striking risk factor was gender, with men twice as likely to die as their female counterparts.
Unsurprisingly, statins were protective in terms of CV mortality. However, unlike what is seen in the general population, NSAIDs were cardioprotective (HR 0.1) in AS patients. Dr. Haroon proposed that this may be due to the beneficial CV effects of reducing systemic inflammation.