Rheumatology Advance Access originally published online on August 5, 2006
Rheumatology 2006 45(10):1319; doi:10.1093/rheumatology/kel260
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Impaired endothelial function in patients with ankylosing spondylitis
General Hospital Linz, Section of Rheumatology, 2nd Department of Medicine, Linz, Austria
Correspondence to: E-mail: herwigpi{at}yahoo.com
SIR, With interest I read the article by Sari and associates [1] in which they describe impaired endothelial function in patients with ankylosing spondylitis (AS). The authors found reduced flow-mediated dilatation (FMD)—a marker of endothelial dysfunction—in AS-patients compared with healthy controls. Sonographically evaluated intima-media thickness of the common carotid artery was comparable in both groups. The authors excluded patients from the study who had traditional cardiovascular risk factors, such as a history of myocardial infarction, diabetes mellitus, hypertension, renal failure, family history of premature coronary heart disease and subjects on lipid-lowering drugs. Even an oral-glucose tolerance test was performed to recognize patients with undiagnosed diabetes. However, patients (and controls) who were smokers were not excluded. Thus, about one-third of the subjects in each group had a history of smoking. I do not understand why those subjects were included in this study, because smoking is clearly known to impair endothelial function [2–4]. Would there be any difference if smokers are excluded from the analysis? In addition, it is not clear why the authors could not find any correlation between smoking and endothelial function, as it seems very likely that smoking has more impact on endothelial function than AS. What is the authors’ explanation for this finding? Comparing all smokers with all non-smokers (regardless of AS) would there be the same FMD in both groups?
There is growing evidence that inflammation plays a major role in the initiation and progression of atherosclerosis [5]. Furthermore, it is now well-known that inflammatory rheumatic diseases such as rheumatoid arthritis, primary systemic vasculitis and systemic lupus erythematosus go along with profound changes in function and structure of the cardiovascular system [6–9]. Whether this is also true for AS remains open to debate. I strongly appreciate the work of Sari and co-workers [1] on this topic, but definitely more data are necessary to clarify the impact of AS on endothelial function and its possible role in the development of premature atherosclerosis.
The author has declared no conflicts of interest.
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- Sari I, Okan T, Akar S, et al. (2006) Impaired endothelial function in patients with ankylosing spondylitis. Rheumatology 45:283–6.
[Abstract/Free Full Text] - Celermajer DS, Sorensen KE, Georgakopoulos D, Bull C, Thomas O, Robinson J, Deanfield JE. (1993) Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 88:2149–55.
[Abstract/Free Full Text] - Wiesmann F, Petersen SE, Leeson PM, et al. (2004) Global impairment of brachial, carotid, and aortic vascular function in young smokers: direct quantification by high-resolution magnetic resonance imaging. J Am Coll Cardiol 44:2056–64.
[Abstract/Free Full Text] - Poredos P, Orehek M, Tratnik E. (1999) Smoking is associated with dose-related increase of intima-media thickness and endothelial dysfunction. Angiology 50:201–8.[Web of Science][Medline]
- Libby P, Plaza A, Maseri A. (2002) Inflammation and atherosclerosis. Circulation 105:1135–43.
[Abstract/Free Full Text] - Gonzalez-Juantey C, Llorca J, Testa A, Revuelta J, Garcia-Porrua C, Gonzalez-Gay MA. (2003) Increased prevalence of severe subclinical atherosclerotic findings in long-term treated rheumatoid arthritis patients wihout clinically evident atherosclerotic disease. Medicine 82:407–13.[Medline]
- Van Doornum XX, McColl G, Wicks IP. (2002) Accelerated atherosclerosis. An extraarticular feature of rheumatoid arthritis? Arthritis Rheum 46:862–73.[CrossRef][Web of Science][Medline]
- Booth AD, Wallace S, McEniery CM, Yasmin, Brown J, Jayne DR, Wilkinson IB. (2004) Inflammation and arterial stiffness in systemic vasculitis: a model of vascular inflammation. Arthritis Rheum 50:581–8.[CrossRef][Web of Science][Medline]
- Raza K, Thambyrajah J, Townend JN, et al. (2000) Suppression of inflammation in primary systemic vasculitis restores endothelial function: lessons for atherosclerotic disease? Circulation 102:1470–2.
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