Spondylarthropathies
No Increased Rate of Acute Myocardial Infarction or Stroke Among Patients with Ankylosing Spondylitis—A Retrospective Cohort Study Using Routine Data

https://doi.org/10.1016/j.semarthrit.2012.02.008Get rights and content

Objectives

To examine if people with ankylosing spondylitis (AS) are at higher risk of acute myocardial infarction (MI) or stroke compared to those without AS.

Methods

Primary care records were linked with all hospital admissions and deaths caused by MI or stroke in Wales for the years 1999-2010. The linked data were then stratified by AS diagnosis and survival analysis was used to obtain the incidence rate of MI and separately cerebrovascular disease (CVD)/stroke. Cox regression was used to adjust for gender and age. Logistic regression was used to examine prevalence of diabetes, hypertension, or hyperlipidemia for those with AS compared to those without.

Results

There were 1686 AS patients (75.9% male, average age 46.1 years) compared to 1,206,621 controls (48.9% male, average age 35.9 years). Age- and gender-adjusted hazard ratios for MI were 1.28 (95% CI: 0.93 to 1.74) P = 0.12, and for CVD/stroke 1.0 (95% CI: 0.73 to 1.39) P = 0.9, in AS compared to controls. The prevalence of diabetes and hypertension, but not hyperlipidemia/hypercholesterolemia, was higher in AS.

Conclusions

There is no increase in the MI or CVD/stroke rates in patients with AS compared to those without AS, despite higher rates of hypertension, which may be related to nonsteroidal anti-inflammatory drug use.

Section snippets

The Secure Anonymized Information Linkage Databank

The Health Information Research Unit in Swansea University is funded by the Welsh Assembly Government to link electronically held routinely collected information to support health-related research. The Health Information Research Unit has set up the Secure Anonymized Information Linkage databank to bring together and anonymize the widest possible range of person-based data, which is performed using a split-file approach to overcome issues of confidentiality and disclosure in health-related data

Validation of GP Database Using a Rheumatology Dataset

Of 116 patients who have an AS code as identified by the rheumatology clinical dataset, 76% (89/116) were also recorded as having AS using GP records. Those not identified by the GP with AS (n = 27) were recorded by the GP as having back pain, knee pain, or other nonspecific symptoms. In addition, 12% (95% CI: 7% to 20%) (13/102) of patients identified within the GP as having AS were found in the rheumatology dataset but with a different diagnosis such as osteoarthritis (n = 5), disorder of

Discussion

This article uses a large dataset of linked longitudinal routine data to build on the evidence base regarding the risk of MI or stroke associated with AS and finds no evidence of a statistically significant increased rate of MI or stroke for those with a diagnosis of AS. In contrast, data from others indicate RA is associated with increased risk of MI and stroke, which accounts for the observed increased mortality in RA (3). Although both AS and RA are types of inflammatory arthritis, there are

Acknowledgments

This study makes use of anonymized data generated by the Secure Anonymized Information Linkage (SAIL) system, which is part of the national e-health records research infrastructure for Wales. We would like to acknowledge all the data providers who make anonymized data available for research.

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This study was funded by the Medical Research Council (MRC) and National Institute of Social care and Health Research (NISCHR). All authors confirm there are no conflicts of interests regarding this work.

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