Ankylosing Spondylitis and Heart Disease: What Is the Relationship?

If you have ankylosing spondylitis (AS), you might be at an increased risk for heart disease. However, it's possible to lower your risk for heart disease by following a nutritious diet and making lifestyle changes.

This article discusses the connection between ankylosing spondylitis and heart disease, the risks of these conditions, as well as how they are treated and prevented.

Connection Between Ankylosing Spondylitis and Heart Disease

Although ankylosing spondylitis (AS) primarily affects the spine, it can also cause complications in other parts of the body—including the heart and surrounding blood vessels.

Several heart conditions that are more common in people living with both AS and heart disease include:

• Aortis: Inflammation of the artery that takes blood from the heart and distributes it to the rest of the body (aorta). Over time, chronic inflammation from AS can lead to aortic valve leakage, which may require surgery to fix.
• Arrhythmia: An irregular heartbeat, including too fast (tachycardia) or too slow (bradycardia).
• Cardiomyopathy: An enlarged, weakened heart that makes it harder to pump blood throughout the body. If not treated, cardiomyopathy can lead to other problems, including the heart suddenly stopping (cardiac arrest), heart failure, and blood clots.
• Ischemic heart disease: In this condition, the blood supply to the heart is reduced. It's usually caused by a blockage in the blood vessels to the heart (coronary artery disease).
• Costochondritis: Inflammation in the cartilage that connects the ribs to the breastbone is not a heart problem but costochondritis can mimic the chest pain of a heart attack.
  

Risks

Heart disease does not increase your risk of developing AS, but having AS increases your risk of heart disease. A 2017 study reported a 30% to 50% higher risk of cardiac events in people living with AS compared to the general population.

Increased risk of heart disease can be linked to:

• Lack of exercise: AS may cause joints to feel too stiff or painful to exercise.
• Pain medication: Healthcare providers often prescribe non-steroidal anti-inflammatory drugs (NSAIDs) for AS-related pain. When used long-term, the drugs can increase the risk of cardiac problems.
• Inflammation: AS can cause inflammation around the aorta.
  

You're at an even higher risk if you have AS and other risk factors associated with heart disease, such as:

• Obesity
  
• High cholesterol
• High blood pressure (hypertension)
• Smoking

A 2020 study found that certain risk factors for heart disease—including high blood pressure, high cholesterol, and obesity—were more common in people diagnosed with axial spondylitis (AS is a subset of this inflammatory rheumatoid condition) than in the general population.

Treatment and Management of AS With Heart Disease

If you have AS and heart disease, your healthcare provider will work with you to find the right treatments, including medication, physical therapy, and possibly surgery.

Medications that are often used to treat ankylosing spondylitis include:

• Biologics (e.g., tumor necrosis factor inhibitors) to help lower or stop inflammation
• Corticosteroids help with pain and reduce inflammation
• Janus kinase (JAK) inhibitors that target the source of inflammation
• NSAIDs for pain management

Usually, these drugs are not prescribed all at once. For example, biologics and JAK inhibitors are only typically prescribed if other medications are not working.

Treatment for heart disease depends on the condition you have but may include:

• Medications such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and cholesterol-lowering drugs
• An angioplasty (a procedure to open blocked blood vessels leading to the heart) with the placement of a stent (a piece inserted in the vessel to keep it open)
• Devices such as a pacemaker (helps the heart beat properly) or implantable cardioverter defibrillator (monitors heart rhythm and automatically administers lifesaving treatment if needed)
• Surgery

If you have AS and heart disease, it's important to watch for any new heart-related symptoms. Contact your provider if you have:

• Changes to the way your heart beats
• Dizziness
• Feeling like you cannot exercise
• Shortness of breath

If you experience chest pain that won't go away, shortness of breath, or pain in your jaw or down your arm, call 911 or seek emergency care right away, as these can be signs of a heart attack.

Prevention

Heart disease is common and it's not always preventable. However, you can make lifestyle changes to lower your risk for heart conditions and prevent any current heart conditions from getting worse.

Know Your Numbers

Have your healthcare provider regularly check your blood pressure, cholesterol, and fat levels in your blood (triglycerides). Trends in these numbers can show the potential effects they are having on your heart health. Talk to your healthcare provider about how to lower any numbers that come back high.

Stop Smoking

Smoking affects all of your body organs, including your heart. Quitting will protect your heart health.

Eat Healthy Foods

Eat a heart-healthy diet that includes:

• Vegetables and fruits
• High-protein foods like fish, lean meats, eggs, and legumes
• Whole grains
• Nuts and seeds

Get Enough Exercise

Exercise improves heart health and can also help you better manage your AS by keeping your joints flexible and mobile. Current federal guidelines recommend that adults get at least 150 minutes of moderate exercise weekly.

Talk to your healthcare team about ways to get more exercise if you're struggling with joint pain and stiffness. For example, a brisk 10-minute walk after each meal could be a place to start.

Summary

When you have ankylosing spondylitis (AS), your risk for heart disease might be higher because of chronic inflammation, long-term use of NSAIDs, and the potential presence of other heart-harming risk factors, like obesity and lack of exercise.

Medications, physical therapy, and sometimes surgery are common treatments for As, while heart disease treatments include medications, implantable devices, and surgery. Both conditions benefit from making certain lifestyle choices like eating a heart-healthy diet and getting enough physical activity.

A Word From Verywell

Although ankylosing spondylitis may increase your risk for heart disease, it's not a sure thing. You can take steps to lower your risk and possibly prevent these outcomes, but it's important to watch for any new symptoms of heart problems and tell your provider right away if you start having them.