Introduction: Cardiovascular (CV) mortality is increased in patients with ankylosing spondylitis (AS), but little is known about CV morbidity beyond the fact that they have a two-fold higher prevalence of ischemic heart disease than controls due to the inflammatory pattern of the disease itself, and a higher prevalence of traditional CV risk factors than the general population. Anti-TNF drugs reduce inflammation and a number of studies have reported a reduction in sub-clinical atherosclerosis in AS patients treated with anti-TNF drugs, thus suggesting that inflammation contributes to their higher CV risk. Anti-TNF drugs also alter the lipid profiles of AS patients, although these changes may reflect their normalization secondary to inflammation control, and improve their other myocardial alterations.

Areas covered: This review concentrates on the risk of cardiovascular morbidity and mortality among AS patients and the effect of anti-TNF drugs on this risk, with particular emphasis on the putative causes involved and the aspects that are relevant in clinical practice.

Expert opinion: The growing evidence of CV disease in AS means that all clinicians need to know how to prevent it and treat patients appropriately. It is important to bear in mind the EULAR guidelines, which state that a rheumatologist is responsible for monitoring all AS patients for signs of CV involvement because this is essential in order to ensure that they are treated properly. As there is little clinical evidence concerning the effects of biological drugs other than anti-TNF agents, treatment should be decided on the basis of the clinical aspects of the type of AS and the CV co-morbidity: for example, patients who are hypertensive or dyslipidemic should immediately start treatment with an anti-hypertensive agent and/or a statin. All of the patients should be educated to prevent CV events by keeping to a balanced healthy diet, avoiding tobacco smoking, and maintaining normal blood pressure, LDL-cholesterol and glucose levels. Finally, all clinicians (but particularly rheumatologists) should always bear in mind CV complications in order to guarantee that the quality of life of AS patients is as good as possible.

简介：强直性脊柱炎（AS）患者的心血管（CV）死亡率增加，但是除了CV的发病率比对照组高出两倍之外，对CV发病率的了解还很少。疾病本身，传统CV危险因素的患病率高于一般人群。抗TNF药物可减轻炎症，许多研究报告称，接受抗TNF药物治疗的AS患者亚临床动脉粥样硬化的减轻，因此表明炎症导致其较高的CV风险。抗TNF药物也可以改变AS患者的血脂水平，尽管这些改变可能反映了继发于炎症控制后的正常化，并改善了他们的其他心肌改变。

涵盖的领域：这篇综述着重于AS患者中心血管疾病发病率和死亡率的风险以及抗TNF药物对该风险的影响，尤其着重于所涉及的推定原因以及与临床实践相关的方面。

专家意见：AS中CV疾病的证据越来越多，这意味着所有临床医生都需要知道如何预防和适当治疗患者。重要的是要牢记EULAR指南，该指南指出，风湿病专家负责监视所有AS患者的CV感染迹象，因为这对于确保正确治疗至关重要。由于除抗TNF药物外，几乎没有其他有关生物药物作用的临床证据，因此应根据AS类型和CV合并症的临床情况决定治疗方法：例如，高血压或高血压患者。血脂异常应立即开始用抗高血压药和/或他汀类药物治疗。应对所有患者进行教育，以保持均衡健康的饮食习惯，避免吸烟，预防心血管疾病的发生，并维持正常的血压，低密度脂蛋白胆固醇和葡萄糖水平。最后，所有临床医生（尤其是风湿病医生）应始终牢记心血管并发症，以确保AS患者的生活质量尽可能好。