IJCS | Volume 32, Nº1, January/ February 2019

16 Table 4 - Results regarding subclinical cardiovascular disease of the individuals up to 40 years of age and those older than 40 years assessed in this study Variables Age group p value ≤ 40 years > 40 years Ankle-brachial index 1.11 ± 0.05 1.06 ± 0.02 0.375 Microalbuminuria 15.04 ± 6.35 5.62 ± 1.10 0.170 CIMT (excluding those with plaques) 1.97 ± 0.88 1.73 ± 0.53 0.811 Carotid plaque No 100.0 (12) 70.0 (21) 0.032 Yes 0.0 (0) 30.0 (9) CIMT (only those with plaques) - 1.45 ± 0.71 - Ankle-brachial index Not altered 75.0 (9) 93.3 (28) 0.097 Altered (< 0.9 or > 1.3) 25.0 (3) 6.7 (2) CIMT (excluding those with plaques) cutoff value Not altered (< 1 mm) 83.3 (10) 71.4 (15) 0.443 Altered (> 1 mm) 16.7 (2) 28.6 (6) CIMT: carotid intima-media thickness. The results are expressed as mean ± standard error of the mean or relative frequency (absolute frequency). P value in the Student t test (quantitative variables) or the chi-square test (qualitative variables). Silva Junior et al. Cardiovascular disease and ankylosing spondylitis Int J Cardiovasc Sci. 2019;32(1)10-18 Original Article population with traditional risk factors for CVD similar to those of the general population, being an independent marker of risk. The presence of carotid plaques and the positive correlation between CIMT and the time since diagnosis of AS in individuals older than 40 years reinforces that hypothesis. In addition, it is worth noting the considerably higher mean value of hs-CRP of the AS group individuals, indicating their higher cardiovascular risk. Furthermore, a good part of those with well-controlled rheumatic disease and low inflammation (ASDAS < 2) were at high cardiovascular risk and out of the recommended LDL- cholesterol target (< 70 mg/dL). We do not know any Brazilian study using this cardiovascular risk stratification approach for those patients, but it is worth noting that some researchers have sought cardiovascular risk markers specific for AS, 23 according to the recommendations established for rheumatoid arthritis and systemic lupus erythematosus. 9 The lackof correlationbetweenmarkersof inflammation, activity and disease impairment in the AS group can be partially explained by the low mean age of the patients or the use of immune biologics in 80% of them. By being a cross-sectional study might have contributed to that, although other authors have found no correlation between inflammation and early atherosclerosis when cardiovascular risk factors were excluded. 13,21 Conclusions There is no difference in the prevalence of manifest CVD in patients with AS as compared to that of the CG. However, subclinical CVD is more prevalent in AS patients when assessed by use of CIMT, has no relation to the AS activity, but to the time since AS diagnosis and to more advanced ages. Most patients with AS are not only at higher cardiovascular risk, even when clinically controlled, but their CVD prevention is inadequate as well. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Universidade Federal do Mato Grosso do Sul under the protocol number CAAE: 34043614.8.0000.0021. All the procedures in this studywere in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. LDL-cholesterol, higher in the AS group, which can be related to the use of immune biologics 20,21 or only to a more cautious diet in the CG. No difference in the prevalence of manifest and subclinical CVDwas found between the groups; however, most individuals were classified as intermediate and high risk. Considering that most individuals in both groups were young, the prevalence of risk factors for CVD at an early age is clear, which is especially relevant in patients with rheumatic diseases. Excluding the limitations of a non-blinded study, the higher mean values of CIMT in the AS group indicate higher subclinical atherosclerosis. Despite the lack of consensus in the literature, 14,22 we believe that such finding reflects early subclinical atherosclerosis in a