Heart Problems and Ankylosing Spondylitis

Reviewed by: HU Medical Review Board | Last reviewed: February 2019 | Last updated: June 2021

Ankylosing spondylitis (AS) not only causes joint inflammation, it can cause extra-articular (beyond the joint) manifestations. One of these extra-articular manifestations is cardiovascular or heart problems.1

Common heart problems with AS

Cardiovascular problems that have been associated with AS include:1,2

  • Left ventricular dysfunction - problems with the left side of the heart which affects the amount and effort required to get blood to the body
  • Aortitis - inflammation of the aorta, the large artery that distributes blood from the heart to the rest of the body. Aortitis can cause high blood pressure or aortic insufficiency, in which not enough blood is distributed to the body.
  • Aortic regurgitation - an insufficient valve in the aorta allows blood to flow backwards or leak into the heart, making the heart work harder to get blood to the body.
  • Arrhythmias - irregularities in the normal rhythm of the heart, such as a heartbeat that is too fast (tachycardia) or too slow (bradycardia)
  • Pericarditis - an irritation and swelling of the sac around the heart (pericardium)
  • Cardiomyopathy - enlarged and weakened heart muscle, which impairs the heart's ability to pump blood to the body
  • Ischemic heart disease - a reduced amount of blood goes to the heart muscle, often due to coronary artery disease
  • Strokes and blood clots - Blood clots can form in the veins which can lead to strokes, deep vein thrombosis (DVT) and pulmonary embolism (PE)

This is not a complete list of all heart problems that can occur in someone with AS. Any symptoms such as chest pain, difficulty breathing or shortness of breath, dizziness, fatigue, irregular heartbeat, swelling of the ankles or feet, or other symptoms which cause you concern should be reported to a doctor.

How common are heart problems in people with ankylosing spondylitis?

Cardiovascular problems are not as common as other extra-articular manifestations of AS, such as inflammatory bowel disease, eye inflammation (uveitis), skin problems, lung and kidney problems. It is estimated that 2-10% of people with AS will develop heart problems.1,3 Patients with AS were at a 30 to 50 percent increased risk of cardiovascular events like stroke or blood clots than to the general population in one large study. Cardiovascular problems are more common in people with long-term AS and those with peripheral joint (arms and legs) involvement.1 In patients with AS, even without a history of heart disease, the arteries may be less elastic than in people without AS.

How does ankylosing spondylitis cause heart problems?

AS causes chronic inflammation in the body. While the inflammation is primarily focused on the joints, particularly the joints in the spine, chronic inflammation occurs throughout the body and can have damaging effects on different organs, including the heart. Chronic inflammation can affect the aorta, causing blockages or damaging the aortic valve. Long-term inflammation can also disrupt the heart's electrical system, causing changes in its rhythm.4

What other characteristics increase a person's risk of heart problems?

High levels of cholesterol and lipids (triglycerides) in the blood increase a person's risk of cardiovascular disease. People with AS should be monitored for their cholesterol and lipid levels and be treated for these as needed to reduce the risk of developing heart problems.4

Other factors that increase a person's risk of developing cardiovascular disease include smoking, being a person who is overweight or has obesity, and an inactive lifestyle. Quitting smoking (or never starting) can reduce a person's risk. Eating a healthy diet, maintaining a healthy weight, and getting regular exercise can also help reduce the risk of heart disease.4

The different heart problems that can occur in people with AS each have their own recommended treatment. Medications and/or surgery may be needed to correct the issue and repair the heart's function.2

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