Association of ischemic stroke with ankylosing spondylitis: a nationwide longitudinal cohort study
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The purpose of this nationwide age- and sex-matched longitudinal follow-up study was to investigate the risk of developing ischemic stroke in ankylosing spondylitis (AS).
The data in this study, spanning from January 1, 2010 to December 31, 2014, was obtained from a database maintained by the Korean National Health Insurance Service. A total of 12,988 patients with a diagnosis of AS were enrolled. The control group consisted of 64,940 age-sex-stratified matching subjects without AS. The 6year ischemic stroke incidence rate for each group was calculated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to estimate the hazard ratio of ischemic stroke.
During the follow-up period, 73 patients (0.56%) in the AS group and 250 patients (0.38%) in the control group developed ischemic stroke (p = 0.0041). The hazard ratio of ischemic stroke in the AS group was 1.46 (95% confidence interval [95% CI], 1.13–1.90) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in the AS group was 1.35 (95% CI, 1.04–1.75) after controlling for demographics and comorbid medical disorders. According to subgroup analysis, in female and diabetes and non-hypertension and dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in AS patients than those in control group.
Our nationwide longitudinal study suggests an increased risk of ischemic stroke in AS patients.
KeywordsAnkylosing spondylitis Stroke Population Epidemiology
This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1D1A1B03032980). This work was also supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HR16C0002).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The need for informed consent was waived because the data used consisted of de-identified secondary data released for research purposes and were analyzed anonymously.
- 4.Brophy S, Cooksey R, Atkinson M, Zhou SM, Husain MJ, Macey S, Rahman MA, Siebert S (2012) No increased rate of acute myocardial infarction or stroke among patients with ankylosing spondylitis—a retrospective cohort study using routine data. Semin Arthritis Rheum 42:140–145CrossRefPubMedGoogle Scholar
- 10.Gratacos J, Collado A, Filella X, Sanmarti R, Canete J, Llena J, Molina R, Ballesta A, Munoz-Gomez J (1994) Serum cytokines (IL-6, TNF-alpha, IL-1 beta and IFN-gamma) in ankylosing spondylitis: a close correlation between serum IL-6 and disease activity and severity. Br J Rheumatol 33:927–931CrossRefPubMedGoogle Scholar
- 21.Park CS, Choi EK, Han KD, Lee HJ, Rhee TM, Lee SR, Cha MJ, Lim WH, Kang SH, Oh S (2017) Association between adult height, myocardial infarction, heart failure, stroke and death: a Korean nationwide population-based study. Int J Epidemiol 4(1):289–298Google Scholar
- 22.Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC Jr, Taubert K, Tracy RP, Vinicor F, Centers for Disease C, Prevention, American Heart A (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107:499–511CrossRefPubMedGoogle Scholar
- 24.Rhee TM, Lee JH, Choi EK, Han KD, Lee H, Park CS, Hwang D, Lee SR, Lim WH, Kang SH, Cha MJ, Cho Y, Oh IY, Oh S (2017) Increased risk of atrial fibrillation and thromboembolism in patients with severe psoriasis: a nationwide population-based study. Sci Rep 7:9973CrossRefPubMedPubMedCentralGoogle Scholar