SAT0354 CARDIVASCULAR RISK IN YOUNG PATIENTS WITH LOW AXIAL SPONDYLOARTHRITIS ACTIVITY: PROMISING SCORING TOOLS
Authors: Elizaveta Vasilenko, Olga Nikolaeva, Anna Dadalova, Maxim Korolev, V Mazurov, Inna Gaydukova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Patients (pts) with axial spondyloarthritis (axSpA) have increased cardiovascular morbidity and mortality, compared to the general population. However, assessment of cardiovascular risk (CVR) in axSpA is complicated, as in age &lt; 40 years conventional CVR scales (SCORE, ets.) are not recommended, as conventional risk factors do not completely determine an increased CVR. The QRESEARCH Cardiovascular Risk Algorithm (QRISK) is the only scale of measuring probability of major cardiovascular events in pts aged 25 to 40. <h3>Objectives:</h3> To measure CVR in young pts with low activity of axSpA, and to evaluate the interrelation between CVR, measured with QRISK and gene predisposition. <h3>Methods:</h3> The study included 46 pts 25-40 years old with axSpA (ASAS criteria 2009), achieved inactive disease on TNF-α inhibitors. AxSpA activity was measured with ASDAS and BASDAI. CVR was calculated with the modified QRISK (QRISK3) (https://qrisk.org/three/). All parameters of QRISK3 were collected: smoking and diabetes statuses, angina or heart attack in a 1<sup>st</sup> degree relative &lt;60, chronic kidney disease (3-5 stage), atrial fibrillation, blood pressure, migraines, rheumatoid arthritis, systemic lupus erythematosus, severe mental illness, atypical antipsychotic medication, regular steroid tablets usage, erectile dysfunction, cholesterol/HDL ratio, systolic blood pressure, Standard deviation (SD) of at least two most recent systolic blood pressure readings (mmHg), height (cm), weight (kg). Gene polymorphisms to main cytokines of axSpA and atherosclerosis pathogenesis were measure (IL17A-197, IL17F7 His/Arg, IL17F-11139 c/g, TNF-863, TNF-308, TNF-238, IL1B-31, IL4-590, IL6-174, IL10-1082, IL10-592, VEGF-2578, VEGF936, MMP2-1306, MMP3-5A6A, MMP9-1562). To identify the relationship between genetic factors and clinical characteristics an exploratory factor analysis was performed. <h3>Results:</h3> Mean age ± SD of included pts was 32.5±3.87 years (26% of pts aged 25 – 30, 28.3% – 30-35, 28.3% – 35-40 years), 36 (78.3%) patient were male, symptoms duration 8.71±4.72 years, duration of TNF-α inhibitor treatment 3.1±2.4 years, ASDAS 1.95±1.23, BASDAI 1.4±0.8. All three age groups were comparable (p≥0.05). Out of the 46 pts 25 – 40 years old 34 (75.6%) had a low CVR and 11 (23,9%) had increased CVR (fig.1). Average QRISK3 score of all the patients was 1.18±1.64%. In the 25-30 year old age QRISK3 was 1.51±0.25%, in pts 30-35years old – 1.09±0.6%, in 35-40 years old–2.31±1.0% (p&lt;0.05 for the intergroup difference). All patients with increased CVR had a direct associations with homozygous in CC allele IL17F-11139 gene, heterozygous in GA allele of TNF-308 and heterozygous in CG allele IL6-174. Negative associations were found between CVR and heterozygosity in His/Arg and homozygous in His/His of IL17F7, homozygosity in GG allele TNF-308, homozygosity in CC IL6-174, table 1. Interrelation of CVR with another gene polymorphisms was not significant (data are not present). <h3>Conclusion:</h3> A quarter of young axSpA pts had an increased 10-year probability of cardiovascular events. Gene polymorphisms in IL-6, IL17F, and TNF-α locuses are strongly associated with increased CVR. QRISK3 and gene polymorphisms could be promising tools in CVR assessment in axSpA. Further larger studies are needed for evaluation of CVR factors in axSpA. <h3>Reference</h3> [1] Julia Hippisley-Cox, et al. BMJ2017; 357 doi: https://doi.org/10.1136/bmj.j2099. <h3>Disclosure of Interests:</h3> Elizaveta Vasilenko: None declared, Olga Nikolaeva: None declared, Anna Dadalova: None declared, Maxim Korolev: None declared, V Mazurov Grant/research support from: JSC BIOCAD, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: paiment from Pfizer, Novartis, Abbvie, Biocad, Selgene, MSD, Sanofy does not exceed 10 000 euros