fetching data ... 
Background: Cardiovascular complications represent a significant burden among patients with ankylosing spondylitis (AS), a chronic inflammatory disease characterized by axial skeletal involvement and systemic inflammation. Persistent inflammation has been implicated in the development of comorbid conditions, including cerebrovascular diseases (CVD), myocardial infarction (MI), and heart failure (HF). Biologic therapies targeting inflammatory pathways have revolutionized the management of AS, potentially mitigating cardiovascular risks compared to conventional non-biologic therapies.
Objectives: This study aimed to compare cardiovascular outcomes in patients with ankylosing spondylitis (AS) treated with biologic versus non-biologic therapies. Key objectives included assessing the incidence of major adverse cardiovascular events (heart failure, myocardial infarction, arrythmias), and all-cause mortality.
Methods: This retrospective cohort study utilized the TriNetX research network, which aggregates data from 135 healthcare organizations. Patients with ankylosing spondylitis (AS) were divided into two cohorts: biologic-treated (BIO; n=11,608) and non-biologic-treated (Non-BIO; n=6,180). BIO patients received agents such as TNF inhibitors or IL-17 blockers, while Non-BIO patients used conventional therapies like methotrexate or sulfasalazine. Inclusion required ≥2 AS diagnoses and treatment records, excluding comorbidities like rheumatoid arthritis and inflammatory bowel disease. Propensity score matching (1:1) balanced 22 covariates across demographics, diagnoses, and medications, resulting in 3,180 patients per cohort. Key outcomes included all-cause mortality, major adverse cardiovascular events (MACE) which includes all these outcomes: cerebrovascular diseases (CVD), myocardial infarction (MI), arrhythmias, inflammatory heart disease, and thrombotic disorders. Outcomes were analyzed over a 10-year follow-up, with statistical significance assessed using t-tests, chi-square, Kaplan-Meier survival, and z-tests (p<0.05).
Results: After propensity score matching, each cohort included 3,855 patients with balanced baseline characteristics. The mean age was 50 years in both groups. Males comprised on average 62% in both groups, with similar ethnic distributions 50% White (Table 1). Statistically significant differences were observed in the following outcomes: The BIO group showed lower rates of: MACE (4.8% vs. 6.2%; p<0.008), All-cause Mortality (1.9% vs. 3.2%; p<0.001), Heart Failure (1.2% vs. 1.9%; p=0.016), cerebrovascular diseases (1.7% vs. 2.4%; p=0.030) and Thrombotic Disorders (eg. DVT, PE) (0.7% vs. 1.2%; p=0.009). Inflammatory heart disease was not observed in the BIO group compared to the non-BIO group (0.0% vs. 0.3%; p<0.002). Non-significant differences were noted in rates of myocardial infarction (BIO: 0.7%; Non-BIO: 0.8%; p=0.430), arrhythmias (4.3% vs. 4.3%; p=0.968), aortic regurgitation (BIO: 0.5%; Non-BIO: 0.4%; p=0.732), and aortic aneurysms (BIO: 0.5%; Non-BIO: 0.4%; p=0.507). Kaplan-Meier analysis showed significantly improved survival in the BIO group, with survival probabilities of 95.11% compared to 91.55% in the non-BIO group (p<0.001). Patients with pre-existing outcomes prior to the time window were excluded from the analysis. A total of 255 patients in the BIO group and 317 in the non-BIO group were excluded due to having at least one of the outcomes (e.g., MACE, CVD, MI, or mortality) before the study period.
Conclusion: This study highlights that ankylosing spondylitis (AS) patients receiving biologic therapies demonstrated lower rates of major adverse cardiovascular events (MACE), all-cause mortality, heart failure, cerebrovascular disease, thrombotic disorders, and inflammatory heart disease compared to those on non-biologic treatment. Although no significant differences emerged for myocardial infarction, arrhythmias, aortic regurgitation, or aortic aneurysms, overall survival was notably improved in the biologic cohort. These findings underscore the potential of biologic treatments to mitigate cardiovascular risks associated with AS compared to non-biologic therapy. By targeting systemic inflammation more effectively, biologic therapies may offer a protective advantage that extends beyond quality of life and joint-related outcomes in this patient population.
Baseline Demographic and Clinical Characteristics After Matching
| Characteristic | BIO Group (n=3,180) | Non-BIO Group (n=3,180) |
|---|---|---|
| Age (years) | 50.6 | 50.1 |
| Female (%) | 61.6% | 63.3% |
| Male (%) | 26.1% | 26.6% |
| White (%) | 50.5% | 51.2% |
| Asian (%) | 37.7% | 35.8% |
| Unknown Race (%) | 54.7% | 57.0% |
| Hispanic or Latino (%) | 43.2% | 41.0% |
| Asian (%) | 19.6% | 18.6% |
| Hypertension (%) | 8.5% | 8.5% |
| Chronic Kidney Disease (%) | 16.7% | 16.8% |
| Diabetes Mellitus (%) | 2.5% | 2.7% |
| Dyslipidemia (%) | 6.6% | 6.9% |
| Chronic Lower Respiratory Diseases (COPD) (%) | 13.4% | 13.7% |
| CRP (mean ± SD, mg/L) | 13.6 | 11.6 |
| ESR (mean ± SD, mm/h) | 21.9 | 18.7 |
| Non-Steroidal Anti-Inflammatory Drug Use (%) | 9.1% | 7.4% |
| Non-Opioid Analgesic Use (Aspirin, Acetaminophen, etc.) (%) | 32.3% | 31.7% |
Cardiovascular Outcomes
| Outcome | BIO Group (n=3,180) | Non-BIO Group (n=3,180) | Risk Ratio (RR) | p-value |
|---|---|---|---|---|
| Major adverse cardiovascular events (%) | 4.8% | 6.2% | 1.30 | 0.008 |
| Cerebrovascular Disease (%) | 1.7% | 2.4% | 1.42 | 0.030 |
| Myocardial Infarction (%) | 0.7% | 0.8% | 1.23 | 0.430 |
| All-cause Mortality (%) | 1.9% | 3.2% | 1.69 | <0.001 |
| Heart Failure (%) | 1.2% | 1.9% | 1.56 | 0.016 |
| Arrhythmia (%) | 4.3% | 4.3% | 0.99 | 0.968 |
| Inflammatory Heart Disease (%) | 0.0% | 0.3% | -- | 0.002 |
| Thrombotic Disorders (%) | 0.7% | 1.2% | 1.89 | 0.009 |
| Aortic Regurgitation (%) | 0.5% | 0.4% | 0.89 | 0.732 |
| Aortic Aneurysm (%) | 0.5% | 0.4% | 0.80 | 0.507 |
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (