IJCS | Volume 32, Nº1, January/ February 2019

11 Silva Junior et al. Cardiovascular disease and ankylosing spondylitis Int J Cardiovasc Sci. 2019;32(1)10-18 Original Article metabolic syndrome, dyslipidemia, hypertension, smoking and family history, have been well established as predictors of cardiovascular events, and measures for their control andmonitoring are recommended to reduce and fight CVD. 3 However, in certain clinical conditions, such as rheumatic diseases, the traditional risk factors do not seem to contribute to the total incidence of CVD. 4 Despite the well described higher incidence of CVD in rheumatic diseases, especially rheumatoid arthritis, systemic sclerosis, systemic vasculitis, antiphospholipid syndrome and systemic lupus erythematosus, it was only recently that the association of CVD and ankylosing spondylitis (AS) gained attention. 5,6 The greater mortality of individuals with AS compared to that of the general population seems to be related to CVD. 7,8 Early atherosclerosis has been reported in association with chronic inflammation and with AS. 9 Some studies have shown that CVD and their traditional risk factors are more prevalent in patients with AS, 10,11 which is still controversial when interpreting inflammation as the major responsible for the higher cardiovascular impairment. Despite the international publications, Brazilian studies correlating CVD and AS are scarce and more recent, especially those assessing their various presentation forms (clinically manifest or subclinical CVD). 12-14 The characteristic racial miscegenation of the Brazilian population increases the interest for such studies, because it can lead to differences in the prevalence of CVD in that population, considering the association between AS and the HLA system. This study was aimed at estimating the prevalence of CVD in individuals with AS from the Spondyloarthritis Outpatient Clinic of the Rheumatology Service of the Mato Grosso do Sul Federal University hospital (HU- UFMS), in addition to correlating the traditional risk factors and the inflammatory process of CVD. Patients and methods This is a quantitative descriptive study carried out from March to October 2015 with individuals with AS selected by convenience and consecutively from the patients regularly cared for at the Spondyloarthritis Outpatient Clinic of the Rheumatology Service of the HU-UFMS, which has records of 170 patients diagnosed with spondyloarthritis (psoriatic arthritis, AS, reactive arthritis, and enteropathic arthritis). Of those 170 patients, 55 were diagnosed with AS. A control group (CG) was formed by convenience sampling with employees of the UFMS without rheumatic disease and was similar to the AS group regarding age and sex. The inclusion and exclusion criteria allowed the selection of 42 individuals for the AS group and 50 for the CG. Before data collection, all individuals providedwritten informed consent, duly registered in the Ethics Committee in Research of the UFMS (CAAE: 34043614.8.0000.0021). Individuals with the following characteristics were excluded: diabetes, indigenous background, hypothyroidism or neoplasia, illiteracy, and pregnant women. All participants were screened for CVD and cardiovascular risk factors. All individuals underwent cardiology clinical examination, laboratory tests, electrocardiography, echocardiography and carotid doppler examination on the same day, and within 20 days from the initial interview, which collected data frommedical history and AS. The laboratory tests, performed after a 10-12-hour fasting, comprised the following measurements: total cholesterol and fractions, glycemia, glycated hemoglobin, uric acid, microalbuminuria, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP) and interleukin 6 (IL-6). The criteria to assess cardiovascular risk according to the V Brazilian Guideline on Dyslipidemia and Atherosclerosis Prevention comprised the presence of dyslipidemia, metabolic syndrome, arterial hypertension, current smoking, family history of early CVD, cardiac hypertrophy, and elevated levels of glycated hemoglobin, uric acid and hs-CRP. 15 Cardiovascular disease was classified as clinically manifest or subclinical. Individuals with manifest CVD were those with history of myocardial infarction, stroke, coronary artery bypass graft surgery (CABG), peripheral revascularization surgery or procedure (PRV), or peripheral obstructive arterial disease (POAD), echocardiographic evidence of segmental, systolic, diastolic (over grade I) or hypertrophic cardiomyopathy, arrhythmias or bundle-branch and atrioventricular blocks on the electrocardiogram, and presence of carotid plaque obstruction > 50% of the lumen on Doppler. Subclinical CVD was identified by an ankle-brachial index (ABI) < 0.9 or > 1.3, a carotid intima-media thickness (CIMT) >1 mm, but without significant plaque obstruction (> 50%) or microalbuminuria > 30 mg/g. 3