IJCS | Volume 32, Nº1, January/ February 2019

15 Figure 1 - Graph showing the carotid intima-media thickness (CIMT) of individuals with and without ankylosing spondylitis. Each column represents the mean, and the bar represents the standard error of the mean. * Significant difference as compared to individuals without spondyloarthritis (Student t test, p = 0.018). No Yes Spondylitis CIMT Silva Junior et al. Cardiovascular disease and ankylosing spondylitis Int J Cardiovasc Sci. 2019;32(1)10-18 Original Article r = -0.362). Among individuals with AS older than 40 years and no carotid plaque, the correlation between time since diagnosis and CIMT was also positive (Figure 2). Medications In the AS group, 34 patients (81%) used immune biologics, 26 (61.9%) used nonsteroidal anti-inflammatory drugs, 13 (31%) were on immunosuppressant drugs (methotrexate/sulfasalazine), and only 4 (9.5%) were using corticosteroids. There was no significant statistical difference between the CG and the AS group regarding the use of statin, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blocker, beta-blocker, calcium-channel blockers, and acetylsalicylic acid. Discussion The higher frequency of cardiovascular impairment in rheumatic diseases, whose major background is chronic inflammation, explains the higher cardiovascular morbidity andmortality of those patients. 18 However, the role of inflammation in the occurrence of CVD remains controversial in AS. Although the prevalence of cardiovascular impairment in AS is not high, 12 there is consensus that the mortality rate of those patients is higher than that of the general population, mainly due to higher cardiovascular mortality. 7,8 In addition, the more accurate definition of the weight of each factor involved, such as chronic inflammation, traditional cardiovascular risk factors and genetics, still lacks. The cyclic characteristic of AS throughout life, the time of exposure to disease, the effect of treatment, and the variety of exposure to cardiovascular risk factors can interfere with the CVD occurrence in that population, hindering the better understanding of the correlation between AS and heart diseases. Unlike rheumatoid arthritis, whose cardiovascular risk score is higher, 9 publications on AS are controversial. Some authors have explained the higher prevalence of subclinical atherosclerotic disease, such as a higher CIMT, in patients with AS because of the higher exposure to cardiovascular risk factors, 7 while others, have reported that the cardiovascular impairment was independent of the presence of the traditional risk factors for CVD. 19 In our study, both groups were similarly exposed to the traditional risk factors for CVD, except for mean