MICROVASCULAR CHANGES OF THE RETINA IN ANKYLOSING SPONDYLITIS, AND THE ASSOCIATION WITH CARDIOVASCULAR DISEASE - THE EYE FOR A HEART STUDY.

• Patients with ankylosing spondylitis (AS) have an increased risk at cardiovascular disease (CVD). Microvasculature changes might precede overt CVD, but have been poorly studied in AS. The small vessels of the retina are accessible for non-invasive visualization, and microvascular changes (retinal arteriolar narrowing, venular widening, loss of tortuosity) are described in association with CVD in other diseases.Objectives:The aim of this study was to compare the retinal microvasculature of AS patients with healthy controls, and to assess gender differences.Methods:A cross-sectional, case-control study comparing AS patients (fulfilling the modified New York criteria, Rheumatology outpatient clinic of Reade and Amsterdam UMC) with healthy controls (EMIF-AD PreClinAD cohort of the Dutch Twins Register(1)), men:women=1:1. Most important inclusion criteria were: age 50-75 years, diabetes mellitus was excluded. All subjects underwent Optical Coherence Tomography Angiography and fundus photography (≥1 eye), analyzed with Singapore I Vessel Assessment software (Table 2). Differences between AS and controls were evaluated with generalised estimating equations (GEE), adjusted for demographics and cardiovascular risk, and stratified for gender.Results:In total, 59 AS patients (mean disease duration 36 years) and 105 controls were included. Controls were significantly older than patients, but did not differ in cardiovascular profile (Table 1). Patients had a significantly lower retinal arteriolar tortuosity (β-0.1;p=0.02), and higher vessel density (β 0.5,p=0.02), than controls (Table 2). Also, male AS patients showed a lower arteriovenular ratio compared to male controls (β -0.03,p=0.04). There were no differences between women with and without AS. In AS, a high disease activity was associated with a wider (unfavorable) venular diameter (p=0.05), whereas biologic use showed a wider (more favorable) arteriolar diameter (p<0.01).Conclusion:This study detected several retinal microvascular changes, in AS patients compared to controls, of which some are associated with CVD based on previous studies. Some changes were only observed in male-, but not in female, patients. A new finding was an increased capillary density in AS, of which the association with CVD-risk has not yet been studied before.References:[1]Konijnenberg E et al. The EMIF-AD PreclinAD study: study design and baseline cohort overview. Alzheimers Res Ther. 2018; 10:75.Table 1.Patient characteristics AS (n=57) and controls (n=105)ASControlspGender, women (%)30 (51)52 (50)nsAge, mean yrs (SD)60 (6)68 (4)<0.01Smoking currently, yes (%)11 (19)8 (8)0.06Body mass index, mean (SD)26 (4)26 (3)nsHypertension, yes (%)23 (39)39 (37)nsDyslipidemia, yes (%)9 (15)18 (17)nsCardiovascular disease history, yes (%)9 (15)15 (14)nsNSAIDS (%)24 (41)6 (6)<0.01Biological (mostly TNF inhibitor)* (%)29 (49)0 (0)<0.01AS Disease Activity Score, mean (SD)2.1 ±0.9Table 2.Retinal vascular parameters, differences AS and Control subjectsCrudeAdjusted for:Age, gender, BMI smoking, hypertension, dyslipidemiaRetinal vascular parametersβ(95%CI)pβ(95%CI)pDiameterArteriolar1.6(-2.0, 5.2)0.37-0.2(-4.8, 4.4)0.92Venular5.4(-0.66, 11.5)0.082.5(-5.4, 10.4)0.53Arteriovenular ratio-0.01(-0.03, 0.01)0.43-0.01(-0.03, 0.02)0.65TortuosityArteriolar-0.05(-0.12, 0.03)0.19-0.1(-0.2, -0.01)0.02ComplexityFractal dimension0.01(0.00, 0.03)0.040.0(-0.02, 0.02)0.88Vessel DensityInner ring0.8(0.5, 1.1)<0.0010.5(0.1, 0.9)0.02Outer ring0.7(0.4, 1.0)<0.0010.2(-0.2, 0.6)0.42Disclosure of Interests:Rianne van Bentum: None declared, Milad Baniaamam: None declared, Buket Kinaci-Tas: None declared, Jacoba van de Kreeke: None declared, Pieter Jelle Visser: None declared, Erik Serné: None declared, Michael Nurmohamed Grant/research support from: Not related to this research, Consultant of: Not related to this research, Speakers bureau: Not related to this research, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma

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