Ankylosing spondylitis (AS) has links to conditions affecting the heart and cardiovascular system, including high blood pressure, atrial fibrillation, heart attack, and stroke.

AS is a type of inflammatory arthritis that primarily affects a person’s back. Scientists do not fully understand why AS seems to increase the risk of heart conditions, but inflammation and genetics could play a role.

Keep reading for more information on how AS affects the heart, the link between AS and cardiovascular disease, and what people can do to minimize the risk.

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Heart disease is a broad term that encompasses multiple conditions. The Spondylitis Association of America (SAA) notes that AS can increase the risk of several, including:

  • ischemic heart disease, which occurs when there is insufficient blood flow to the heart, bringing on symptoms such as chest pressure, angina, and a low tolerance for activity
  • conduction disturbances that can cause the heart to beat too slowly or quickly
  • cardiomyopathy, which is an enlargement and weakening of the heart
  • aortitis, which refers to inflammation of the aorta

A 2018 meta-analysis also notes that people with AS have a higher risk for a cardiovascular event, such as a heart attack or stroke.

However, this does not mean everyone with AS is guaranteed to develop cardiovascular disease.

Although scientists do not yet fully understand the connection between AS and the heart, there are some theories.

Chronic inflammation

The Arthritis Foundation states that any health condition, including inflammatory arthritis, can strain the heart over time. Having inflammatory arthritis can increase the risk of:

  • heart attack
  • stroke
  • atrial fibrillation, or an irregular heartbeat
  • atherosclerosis, which refers to the buildup of plaque in the arteries
  • high blood pressure
  • heart failure

Experts believe chronic inflammation may also be a factor in the relationship between AS and cardiovascular problems.

Genetic factors

In a 2018 study, researchers looked at the prevalence of coexisting conditions in 6,679 adults with AS. In comparison with a control group, people with AS had higher rates of:

  • hypertension, or high blood pressure
  • angina
  • atherosclerosis
  • myocardial infarction, or heart attack
  • cerebrovascular disease or stroke
  • venous thromboembolism
  • coronary artery disease

Although the researchers did not specifically look at causes, they stated that genetics might be responsible for the higher rates of cardiovascular disease in those with AS. The commonalities between both conditions might make AS a marker for heart disease.

Research into the genetics of AS and how this might affect other aspects of health is still ongoing.

Another factor in AS and its relationship with heart disease could be the medications people often take to manage the symptoms.

A person needs to consult a doctor about the effects of their medications. The doctor can help assess the person’s risk factors and recommend an appropriate course of treatment.

Some medications for AS that may affect heart health include:

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a standard treatment for AS. Examples of NSAIDs include ibuprofen (Advil) and naproxen (Aleve).

According to the SAA, several studies indicate that the long-term use of NSAIDs increases the risk of cardiovascular events, such as heart attacks.

However, in a 2015 study involving more than 400 people living with AS, researchers found that infrequent use of NSAIDs presented a higher risk of cardiac events than regular, long-term use.

The study authors noted a significantly reduced risk of cardiac events after 12 months of NSAID use. They took these findings as evidence that long-term use of NSAIDs is safe for people living with AS.

However, since 2005, the Food and Drug Administration (FDA) has warned of the increased risk of heart attack and stroke with the use of NSAIDs. In 2015, it issued an updated statement strengthening this warning.

Prednisone and DMARDs

Prednisone is another medication that doctors use in the management of AS. Although it reduces inflammation, health experts know this medication raises blood pressure and cholesterol levels. It can also contribute to atherosclerosis.

Disease-modifying antirheumatic drugs

Similarly, disease-modifying antirheumatic drugs (DMARDs), including methotrexate, have a greater risk of heart attack and stroke in comparison to tumor necrosis factor blocker biologics.

Heart disease is not inevitable for everyone who has AS. While the condition may elevate the risk of developing heart disease, there are things people can do to lower the risk.

The SAA suggests taking the following steps to protect heart health:

  • quitting or avoiding smoking, if applicable
  • eating a balanced diet
  • maintaining a moderate weight
  • engaging in regular exercise
  • remaining consistent with treatments for AS

The Arthritis Foundation states that exercise can be particularly challenging for people living with arthritis due to symptoms such as joint pain. The organization suggests working with a doctor or physical therapist to develop an exercise routine that does not cause unnecessary pain.

Regular doctor visits should be part of all AS management. A person can speak with their doctor about their risk of heart disease and discuss plans to protect their health.

A person’s doctor can recommend any necessary lifestyle adjustments, such as exercising more frequently or making dietary changes, to reduce the risk of heart disease. They can also help monitor a person’s heart health by regularly testing their blood pressure and cholesterol levels and checking the heart for irregularities.

A person should seek emergency medical attention if they experience any symptoms of a stroke, such as sudden paralysis or weakness, or a heart attack.

Is it a heart attack?

Heart attacks occur when there is a lack of blood supply to the heart. Symptoms include:

  • chest pain, pressure, or tightness
  • pain that may spread to arms, neck, jaw, or back
  • nausea and vomiting
  • sweaty or clammy skin
  • heartburn or indigestion
  • shortness of breath
  • coughing or wheezing
  • lightheadedness or dizziness
  • anxiety that can feel similar to a panic attack

If someone has these symptoms:

  1. Dial 911 or the number of the nearest emergency department.
  2. Stay with them until the emergency services arrive.

If a person stops breathing before emergency services arrive, perform manual chest compressions:

  1. Lock fingers together and place the base of hands in the center of the chest.
  2. Position shoulders over hands and lock elbows.
  3. Press hard and fast, at a rate of 100–120 compressions per minute, to a depth of 2 inches.
  4. Continue these movements until the person starts to breathe or move.
  5. If needed, swap over with someone else without pausing compressions.

Use an automated external defibrillator (AED) available in many public places:

  1. An AED provides a shock that may restart the heart.
  2. Follow the instructions on the defibrillator or listen to the guided instructions.
Was this helpful?

Ankylosing spondylitis (AS) has associations with several types of heart disease, but scientists are still learning why. The link could be due to the underlying inflammatory activity, genetic links between both conditions, or the effects of certain AS medications. However, research is still ongoing.

A person can take preventive steps to reduce their risk of heart disease, such as maintaining a moderate weight, eating a nutritious diet, and exercising regularly. A person can also consult a doctor about treating their AS. Additionally, monitoring any risk factors for cardiovascular disease should also be part of their treatment plan.