Ankylosing spondylitis is characterized by inflammation in certain joints, mainly the sacroiliac joints (where the spine attaches to the pelvis), the spine, and the hips. This inflammation causes symptoms such as low back pain and stiffness.
The same inflammation that causes this pain may also be responsible for the elevated heart risks seen in people with AS. Specifically, the inflammation can accelerate atherosclerosis, leading to other forms of heart disease and cardiovascular events.
Ankylosing spondylitis isn’t the only form of arthritis linked to heart disease, says David Pisetsky, MD, a rheumatologist and professor of medicine at the Duke University School of Medicine in Durham, North Carolina.
“Most rheumatic diseases are associated with increased risk for cardiovascular disease,” Dr. Pisetsky says. “AS, rheumatoid arthritis, psoriasis, and lupus all have inflammatory components, and when the immune system gets inflamed, it may play out in the cardiovascular system as much as the joints.”
Some heart conditions may also be determined genetically. According to a large genome-wide association study of European populations, there’s a possible genetic link between AS and:
Heart failure
High blood pressure
Ischemic stroke
This could mean that AS directly causes heart disease through a genetic link, although the exact mechanisms behind this link remain unknown.
The same study found no genetic link between AS and:
Coronary heart disease
Cardiomyopathy
Heart valve disease
In other studies, heart arrhythmias and atherosclerosis were not found to have a genetic component.
People with ankylosing spondylitis are also more likely to have high cholesterol and high blood sugar (hyperglycemia) and to be overweight or obese — all factors that further increase heart disease risk, says Susan Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City.
Costochondritis Pain vs. Heart Attack
Many people with AS also have a condition called costochondritis, which is a benign (harmless) inflammation of the cartilage that connects your ribs to your breastbone. Costochondritis usually goes away on its own, but it can cause severe chest pain that’s often confused with the pain of a heart attack.
Seek medical attention if you’re experiencing chest pain, so your doctor can help rule out more serious conditions. If the cause of your pain is costochondritis, they can recommend breathing exercises, stretches, or medication to help you manage the pain.
